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, October 11, 2018

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

October 11, 2018 Edition.
What a week in the US with all sorts of Judge K. controversy ending with his confirmation, Trump being a totally disrespectful jerk and claiming great success for his new NAFTA – which is the old one with a few tweaks….
Just read this and weep is my view….
Worse the share market has crashed so he is failing on his main KPI!
 
Somehow Theresa May is still UK PM. I have got no idea how or why?
In OZ ScoMo is a bit like the “energiser bunny” running around trying to fix things. I am not sure it will help….
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Major Issues.

  • Updated Oct 1 2018 at 6:34 AM

Stan Druckenmiller sees 'massive' debt fuelling next financial crisis

by Krista Gmelich
New York | Billionaire investor Stan Druckenmiller says the next financial crisis will be worse than the last due to soaring levels of debt.
"We have this massive debt problem," Druckenmiller said an interview with Kiril Sokoloff, chairman of 13D Global Strategy & Research.
"We tripled down on what caused the crisis. And we tripled down on it globally."
Druckenmiller joins a growing list of Wall Street financiers and money managers who have predicted debt will trigger a crisis.
Citadel's Ken Griffin last week cautioned that a debt-fuelled buying binge is laying the seeds for the next economic downturn. 
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Digital disruption is changing us for better and worse

By Ross Gittins
1 October 2018 — 9:08am
The rise of the internet and other aspects of the digital revolution has changed our working and private lives – mainly for the better. But all technological advance has its downside. We tend to soon take the benefits for granted and are only starting to understand the costs.
To start with the latest, how many of us watched every moment of either of both grand finals, compared with how many of us actually attended the ground?
If many of us did neither, it’s because digitisation has greatly multiplied the range of rival entertainments available to us – including while we’re supposed to be working.
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Sydney housing drops at fastest pace since GFC

October 1, 2018
Sydney housing prices are dropping at the fastest pace since the global financial crisis, losing 6.1 per cent over the past year as Australia marks 12 months of falling values.
Prices are likely to keep falling for another six to 12 months and could shed as much as 10 per cent nationally, according to property researcher CoreLogic.
A regulatory crackdown on lending has been taking the heat out of the market, while the scrutiny of the financial services royal commission has also prompted lenders to be more conservative. Borrowers are now facing out-of-cycle interest rate hikes and many households have significant debt burdens.
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Watchdog’s crackdown on super funds quietly watered down

  • 12:00AM October 1, 2018
The federal government has quietly dropped proposals for the corporate watchdog to take a closer interest in the scandal-ridden superannuation sector and that its minister front parliament every year to explain its performance.
A “statement of expectations” of the corporate regulator by the government was completed in April, but it and the Australian ­Securities & Investments Commission’s response were made public only on Friday — the same day the banking royal commission released its scathing 1000-page ­interim report.
The watered-down response comes despite tough talk yesterday from Scott Morrison, who on Saturday claimed the government had beefed up ASIC’s enforcement abilities.
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Reality check: The era of interest rates at 5000-year lows is ending

By Peter Hartcher
2 October 2018 — 12:00am
Have you ever had one of those moments when you're caught up in something that seems perfectly normal only to have a sudden realisation that it's actually quite unnatural and abnormal?
You might be on a plane absorbed in a movie and something snaps you out of it to remind you that you're moving at three-quarters the speed of sound, 10 kilometres above the planet, amid Arctic temperatures. There is nothing natural or normal about this.
Last week the world economy was given one of those moments of reality check. For the first time in 10 years, America's central bank stopped handing out free money. I think you'd agree that it's not normal for banks to hand out free money.
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Five myths about capitalism

It turns out that these 'truisms' of the market aren't actually true at all.

By Steven Pearlstein
2 October 2018 — 12:07am
Thirty years ago, in the face of a serious economic challenge from Japan and Europe, the United States embraced a form of free-market capitalism that was less regulated, less equal, and more prone to booms and busts. Bolstering that embrace was a set of useful myths about motivation, fairness and economic growth that helped restore American competitiveness.
Over time, however, the most radical versions of these ideas polarised US politics, threatened its prosperity and undermined the system's moral legitimacy. (A recent survey found that only 42 per cent of millennials support capitalism.) Here are five of the most persistent ones.
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Bank home loan tactics undermine 'customer first' claims

By Clancy Yeates
2 October 2018 — 11:00am
All the banks profess to put customers first, but the past few months have underlined a growing contradiction in this claim and it is getting increasingly hard for the industry to ignore.
If banks really want to focus on their customers' needs, why do they offer new borrowers cheaper home loans than loyal clients, who have banked with them for years?
It's a tricky one to answer convincingly. And it's an issue a growing number of banks, analysts and regulators are grappling with, as the industry tries to repair its reputation.
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  • Oct 3 2018 at 10:45 AM

Six signals tougher times are on their way

Some less obvious economic indicators have joined falling property prices as a pointer to some tougher times ahead in Australia.

House price pain trickles down

Morgan Stanley equity strategist Chris Nicol and his team outlined in a report last week that the house price declines previously quarantined to more expensive houses - the top quartile - were now making their way into lower-priced properties.
The impact on consumer spending now that the "wealth effect" was spreading into middle Australia would likely be much more keenly felt.
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  • Updated Oct 4 2018 at 7:53 AM

US bond yields surge on data, smacking the Australian dollar

Washington | The US bond market is on fire, with the benchmark 10-year yield galloping to its highest level since 2011 as investors raise bets America's economy will continue to leave the rest of the world behind.
In a surge that threatens to generate an unwelcome upward pressure on Australian bank funding costs for mortgages, the difference between yields in the US and the rest of the world have also widened dramatically.
The Australian dollar, already vulnerable to weakness in emerging markets, slipped almost 1 per cent to US71.18¢, extending its year-to-date tumble against the greenback to 8.8 per cent. The gap between the US 10-year Treasury and its Australian equivalent reached 52 basis points about 5am AEST.
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  • Updated Oct 3 2018 at 11:00 PM

Global growth fears stoked by slowing factory activity

Trade tensions between the US and China may be coming home to roost for the global economy, with the most closely watched manufacturing surveys flashing warning signs from China to the euro-zone.
Chinese factory activity slowed in September, official and private surveys showed, as the world's second biggest economy remains locked in a trade dispute with the US. Manufacturing also faltered in Vietnam, Taiwan and Indonesia last month.
With many of Australia's largest companies exposed to the ebb and flow of global growth, notably mining, energy and transport plays, the slowing of activity in the world's factories needs to be added to the growing number of risks confronting investors that include higher US interest rates, elevated valuations and simmering geopolitical tensions.
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Architect of Paris climate accord says Morrison government's emissions stance is 'anti-science'

By Nicole Hasham
3 October 2018 — 11:45pm
A key architect of the landmark Paris climate deal has lambasted the Coalition government’s inaction on greenhouse gas emissions, saying it “goes against the science”, squanders economic opportunity and risks Australia’s international standing.
Laurence Tubiana, a respected French diplomat and economist, also says Prime Minister Scott Morrison’s claim that Australia will meet its Paris targets “at a canter” is contradicted by international scientific opinion.
Her comments follow an official report on Friday showing Australia’s climate pollution rose by 1.3 per cent in the year to March – the highest quarterly rise in eight years. The troubling findings were released on the eve of the long weekend in some states and on the same day as the banking royal commission interim report - timing critics say was designed to bury the report.
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  • Oct 4 2018 at 11:13 AM

Mortgage payments to near 20-year high: PIMCO

Rising mortgage costs will hit housing affordability at a time when dwelling prices are falling, as home loan servicing costs rise to highs not seen since the global financial crisis, PIMCO warns.
Higher wholesale funding costs for retail banks, worsened by concerns about a deteriorating housing market, will increase the repayment burden that for many home buyers is already increasing as lenders switch to principal-and-interest loans from interest-only loans, the bond fund manager said in a report.
"We estimate that a 200-basis-point increase in Australian mortgage rates, a commonly adopted stress-test assumption at mortgage origination, could increase mortgage payments from 38 per cent of pre-tax income to close to 48 per cent," PIMCO said in its October 2018 Viewpoint report.
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  • Oct 5 2018 at 12:00 AM

Sally McManus will pressure a Shorten government to go back to the future

The latest speech by ACTU secretary Sally McManus is also the latest example of the union pressure that will come on a Shorten Labor government to change the rules governing Australia's industrial relations.
Most employers may think those rules – and their interpretation by the Fair Work Commission – are already heavily weighted against them. But the union movement is determined to use the prospect of a Labor government to extend its power. That ability may seem limited in a system where less than 10 per cent of the private sector workforce are union members.
Yet while union membership may be way down, union leadership has certainly not lost commensurate influence – particularly over the Labor Party. That's mainly thanks to the reach of some key unions with considerable financial resources.
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We are sleepwalking into an era of unprecedented danger

By Catherine McGregor
4 October 2018 — 3:20pm
Last week, Jacinda Ardern received rapturous acclaim for her address to the United Nations General Assembly. Ardern is an inspiring, authentic leader. I admire her. Her speech was both eloquent and expressed noble sentiments. It provided a stark contrast to the ramblings of the American Caligula who is presiding over the death throes of Pax Americana. Yet despite my regard for Ardern and my contempt for US President Donald Trump, her clarion call for collaboration and multilateralism is likely to fall on barren ground as the post-war liberal order she defended collapses with the decline of American capability and resolve.
But it was a speech that only a New Zealand prime minister could give. She spoke for a harmonious nation blessed with benign strategic geography, social harmony and prosperity. As David Lange once quipped, New Zealand is “a dagger pointed at the heart of Antarctica”. Even as Australia entered peak torpor with a long weekend and football finals in our most populous states, there were disconcerting reminders that we inhabit an unstable region.
Our strategic circumstances are deteriorating rapidly, yet we are seemingly oblivious to the rapidly changing world. We are not so much the Lucky Country as the Land of Laughter and Forgetting. Our parochial complacency has been inculcated by a venal, short-sighted leadership caste, a media distracted by the jejune culture war and savage cuts to overseas postings. We gaze fondly at our navel while the global order upon which our prosperity and security rest unravels.
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How Trump’s bubble may affect your mortgage

By Stephen Bartholomeusz
4 October 2018 — 4:41pm
The spike in US long-term bond yields overnight to their highest level in more than seven years says something positive about the current state of the US economy while also hinting at the threat to the sustainability of Trump’s economic boom.
US 10-year bond prices crashed and yields jumped by 12 basis points overnight, to 3.18 per cent (as bond prices fall, their yield-to-maturity rises), causing the US dollar to surge against America’s major trading partners and the US stockmarket to slide.
Financials stocks drove Wall Street higher on Wednesday, and the Dow closed at a record high for the second straight day.
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  • Updated Oct 5 2018 at 6:20 PM

US-China clash in the South China Sea is a huge problem for Australia

"We'll drift placidly down the stream, quite possibly heading for a waterfall."
These are the words of Hugh White, a senior Australian defence and foreign policy strategist, referring to the dramatic increase in tension between the world's two superpowers, the US and China, and the danger this holds for Australia.
While the two global giants sort-of got along in the past, Australia paddled on into greater wealth from booming exports to China while remaining sanguine about its place in the world because of US security guarantees. But when strategic conflicts like the South China Sea and economic conflicts like the escalating US-China trade war conflate, as they did this week, the Australian canoe may head for the waterfall.
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  • Updated Oct 5 2018 at 11:00 PM

Solar power could have to be curtailed to avoid grid disruption

The solar rooftop boom has migrated from homes to industry. Nick Lenaghan
The record uptake of subsidised rooftop solar power into homes and businesses in some areas is beginning to affect grid power quality and forcing policymakers to consider the unthinkable – the need to curtail flows of solar power into the grid.
The grid hasn't kept pace with the explosion of homeowners wanting to export surplus energy back into the grid, setting up a two-way flow the centralised networks weren't designed for and reducing power quality. 
Poor power quality might mean that lights flicker or dim when an energy-hungry appliance like a pool pup is switched on. Surplus wind and solar power can also turn wholesale electricity prices negative, forcing high cost generators out of the market.  
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Fairfax-Ipsos poll: Quarterly analysis shows huge road ahead of Scott Morrison and the Coalition

By David Crowe
5 October 2018 — 11:45pm
Prime Minister Scott Morrison is facing a mammoth task in winning back voters before the next election as a new analysis shows the Coalition is trailing Labor by 47 to 53 per cent in two-party terms.
The results confirm a horror slump for the federal government since the last election and reveal the scale of the challenge for Mr Morrison after the Liberal Party dumped Malcolm Turnbull as leader in August.
The government has lost ground in key states and fallen behind with female voters, trailing Labor by 45 to 55 per cent when people are asked how they would allocate their preferences.
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The great divide driving voter disgust

By Matthew Lesh
6 October 2018 — 12:05am
Australians are frustrated, disengaged and pessimistic. There is widespread and growing dislike of politicians, the political process and lacklustre policy outcomes. Australians think that the system is being stacked against them, their communities, families and potential for human flourishing.
"Public satisfaction with our democratic processes and public trust in the politicians we elect are at some of the lowest levels ever recorded," Professor Ian McAllister of the Australian National University surmised after the 2016 election. Just a third of Australians are satisfied with the way that democracy is working. Three-quarters think that "our government does not prioritise the concerns of people like me" – among the highest in the developed world.
Australia’s shambolic political predicament is caused by a new divide driven by different identities, lifestyles and cultures.
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Big government is good

By Ebony Bennett
6 October 2018 — 12:00am
Australia is on track to eliminate cervical cancer by 2035. Co-inventor of the vaccine Professor Ian Frazer believes it will eventually be eliminated globally, like small pox. It is a truly remarkable feat of human ingenuity. Eliminating cervical cancer is also an unqualified success story of how government can and should improve the lives of its citizens. And it is not the only success story that should make us question the neoliberal commitment to what is euphemistically called 'lean government'. Big government is good.
Neoliberalism partly defines itself by its commitment to small government; the idea that government should stay out of (rich, white) people's lives, that the private sector is always more efficient than the public sector and that we should reduce burdensome red tape for business (but not unions). But it was big government intervention ten years ago that led to one of the world's biggest public health success stories and there's another ten-year anniversary approaching that should make us applaud the merits of big government that serves the interest of its citizens.
One week from tomorrow, the Australia Institute will host an event to mark the 10th anniversary of the Rudd government's $52 billion stimulus package, which successfully prevented the global financial crisis from sending Australia into recession with the rest of the world.
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Why so many businesses are behaving badly

By Ross Gittins
6 October 2018 — 12:15am
While we digest the royal commission’s evidence of shocking misconduct by the banks and insurance companies, there’s another unpalatable truth to swallow: they have no monopoly on bad behaviour.
It seems almost everywhere you look you see examples of companies behaving badly. In a major speech he gave a few months ago, the chairman of the Australian Competition and Consumer Commission, Rod Sims, offered a remarkable list of business household names the commission was taking proceedings against, as I noted at the time.
Commissioner Kenneth Hayne has given us a lawyer’s explanation of why the banks misbehave, but Sims’ speech offers an economist’s explanation.
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Pacific crisis a direct threat to Australia

By Peter Hartcher
6 October 2018 — 12:00am
To most Australians, the South Pacific looks like a holiday opportunity or a blank space on the map. It takes a crisis for Australia to pay serious attention to the Pacific islands.
Like when the Japanese occupied several to prepare for the full-scale invasion of Australia in World War II.
Or when the Solomon Islands became a failed state and turned to Australia in desperation in 2003, leading to the 14-year, multibillion-dollar RAMSI mission. Or when civil war broke out on Bougainville and Australia and New Zealand were asked to oversee the peace process from 1997.
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Minority report: crackdown on facial recognition technology in schools

By Henrietta Cook
5 October 2018 — 11:30pm
Victoria's Education Minister James Merlino is clamping down on facial recognition technology in schools, saying the software's privacy risks makes him “uncomfortable”.
While it might sound like a scene from a sci-fi movie, a small number of Victorian schools have been trialling scanners that sweep classrooms for students’ faces to ensure no one is missing.
But privacy concerns about the technology has promoted the education minister and Victoria’s inaugural Information Commissioner to sound the alarm.
Mr Merlino has ordered the Education Department to immediately assess the software and report back to him.
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Productivity Commission to examine mental health spending in wake of suicide crisis

By Michael Koziol
7 October 2018 — 12:00am
The Productivity Commission will undertake a major inquiry into the role of mental health in the economy as the Morrison government looks to extract better value from the $9 billion a year spent on mental wellbeing.
Treasurer Josh Frydenberg and Health Minister Greg Hunt have asked the commission to examine "whether the current investment in mental health is delivering value for money", as well as how to improve economic and social participation for people struggling with their mental health.
Four million Australians deal with a chronic or episodic mental health issue each year, and one in five people affected by mental illness do not seek help because of the stigma, Mr Hunt said.
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Got a political problem? Commission a report

By Jacqueline Maley
7 October 2018 — 12:01am
Craig Kelly, the Member for Hughes, has twice travelled to Azerbaijan, courtesy of the Azerbaijani taxpayer, to inspect their electoral system.
He has declared it admirable, according to the Azerbaijan media, who reportedly quoted him as saying he had witnessed a “coherent, democratic process” and “an election organisation that surpassed Australia’s experience”.
Kelly’s opinion on the integrity of Azerbaijani democracy is delightfully idiosyncratic - it is a country where the President took over from his own dad in 2003, appointed his wife Vice-President, extended his own term in an extra-electoral sleight of hand and was this year re-elected with 86 per cent of the vote.
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Financial Services Royal Commission Issues.

  • Updated Sep 30 2018 at 11:00 PM

It's not lack of resources: Hayne report shows regulator ASIC has been captured

by Rod Maddock
The Interim Report of the banking royal commission is clear, firm and direct. A wide variety of financial institutions has been able to pursue its own private interests virtually unchecked. Neither the law, nor its enforcement, has been effective.
Some of the issues seem conceptually quite straightforward. Compliance with responsible lending law and regulation has been patchy, with the commission finding many cases of inappropriate lending. While the stories have been individually harrowing, banks will know how to fix these problems. Better internal processes, agreements about what are appropriate treatments of customers in difficulty, and remediation will all have to be redesigned, but these are practical rule-driven fixes which are "normal" problems that banks deal with every day.
How to give advice poses a more difficult problem. Advice is normally given face-to-face and as with any human interaction is subject to vagaries of personality, to ambiguities, and to misunderstandings. For most households, decisions about how to invest, which home loan to take out, and which insurer to use are infrequent decisions but potentially of great significance. The seller inevitably knows more than the buyer and the buyer is looking for guidance, often from the seller.
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  • Updated Sep 30 2018 at 11:00 PM

Banking royal commission: Time to start again with conflict-ridden wealth sector

If the interim report from Royal Commissioner Ken Hayne provided one ray of hope for the Commonwealth Bank, ANZ Banking Group and National Australia Bank it was this: The decision to get rid of their wealth businesses has been completely and utterly justified.
If the report describes the entire banking sector as riven by greed, then the financial advice sector is the lowest of the low.
This is an industry where the interest of the client conflict so badly with those advising them that mums and dads seem more likely to have their interests trod on than not.
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  • Sep 30 2018 at 11:00 PM

Banking royal commission interim report: Wealth industry needs an overhaul

"Why do staff (whether customer-facing or not) need incentives to do their job unless the incentive is directed towards maximising revenue and profit?"
It was a simple yet profound question posed by Commissioner Kenneth Hayne in his interim report into the royal commission into misconduct in the banking, super and financial services sector.
If applied to all layers of staff, aligned financial advisers, introducers, brokers and other intermediaries, it would have a massive impact on a sector that has fostered a culture of greed and gouged customers any way it could to meet profits and earn bonuses.
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  • Updated Sep 30 2018 at 11:45 PM

Josh Frydenberg wary of banking royal commission rules hurting economy

Treasurer Josh Frydenberg has revealed he will not rush to impose heavy-handed regulation on financial companies despite the royal commission's scathing assessment that greed in the sector had failed consumers, because ill-considered rules could constrict lending and hurt the economy.
The Treasurer wants to avoid layering new rules on financial institutions that could tighten credit to households or business, or have the unintended consequence of wiping out smaller competitors to the major banks – such as mortgage brokers – and make the big four lenders more dominant.
Instead for now, the Morrison government is pressuring financial firms and regulators to significantly clean up the industry's cultural problems, including via reforms it has unveiled to hold bank executives accountable and beefing up the intensity of the Australian Securities and Investments Commission.
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  • Updated Sep 30 2018 at 6:08 PM

Show and tell at the banking royal commission

Banks have put 'profits before people'
Follow the money. The interim report of the Hayne royal commission demonstrates the importance of applying a very traditional concept in understanding motive and result. Follow the money.
According to Commissioner Kenneth Hayne, the answer to why so much egregious behaviour occurred is far too often fairly simple – "greed" . So selling became the focus of attention for banks and other financial services entities, he says, often the sole focus of their attention.
"From the executive suite to the front line, staff were measured and rewarded by reference to profit and sales," his report notes, leading to the pursuit of short-term profit at the expense of basic standards of honesty.
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  • Oct 1 2018 at 4:17 PM

Royal commission interim report: The questions facing the banks

Royal Commission is leaving no stone un-turned
Four days ago Commissioner Kenneth Hayne was driven through the gates of Government House in Yarralumla to deliver his interim report on misconduct in the banking, financial services and superannuation industry by hand.
While the waiting packs of journalists, analysts and perhaps even the Governor-General himself were not expecting the interim report to hand them answers on a silver platter, they probably weren't expecting to receive 693 questions spread over three volumes either.
Some of the questions posed by the royal commission appear straightforward. Others are complex on first reading. However, often the simple questions posed by Hayne are in some cases more complex than they appear and the more complicated questions lead readers down a narrow path.
Notwithstanding their immediate complexity, they are the most important questions facing the Australian banking industry in our lifetime. What follows below is a list of those that have the most potential to shake up the system.
Labor demands an extension on the Royal Commission
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  • Updated Oct 1 2018 at 11:45 PM

RBA, Treasury warn regulatory response to Hayne commission risks credit crunch

The Reserve Bank of Australia and Treasury have privately cautioned the Morrison government that any regulatory response to the financial services Royal Commission must be careful to avoid putting the brakes on lending to home buyers and business.
The advice from two of the country's top financial policy agencies appears to partly explain why Treasurer Josh Frydenberg has signalled he must balance cracking down on nefarious misconduct in the industry and ensure credit keeps flowing to borrowers to grow the economy.
The Treasurer has said he also wants to make sure any new rules don't inhibit competition – such as from mortgage brokers – against the big banks.
Sources said the RBA and Treasury had confidentially emphasised to the government the importance of avoiding a credit squeeze.
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  • Updated Oct 1 2018 at 5:03 PM

Banking royal commission interim report: Funeral insurance all but dead

Funeral insurers will have to overhaul their products or ditch them altogether  after the Hayne royal commission called on the corporate regulator to use its new product intervention powers to shut down junk funeral insurance.
The royal commission exposed systemic rorts in the funeral industry, where insurers on average only pay out about one third of the premiums collected.
Indigenous consumers are disproportionately affected because of the cultural significance of the "sorry business" in the community.
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Fears royal commission fallout could turbocharge property falls

By Elizabeth Knight
2 October 2018 — 12:15am
Bank investors on Friday delivered a verdict on the interim report of the royal commission into financial services - it could have been worse. By Monday, the market seemed to reverse this decision, with major bank stocks retracing Friday’s share price gains and then some.
After the initial relief that Commissioner Kenneth Hayne suggested the banking industry didn't need a raft of new laws and regulations, it just needed to obey those already in place, investors began to realise that the outcome could be the same.
September marks 12 months of consistently falling house prices since it's peak last year.
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Economy can’t afford credit growth based on dodgy practices

  • 12:00AM October 2, 2018
Judging by the interim report of the Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry, it must be said that, for a lawyer, Ken Hayne is a pretty good economist.
He clearly understands the possibility of unintended consequences and the danger of making already complex laws even more complex. He wants the regulators to enforce the laws that exist, ­impartially and with force.
In his opinion, there are some arrangements, while not perfect, that are best left alone — for example, in relation to business lending and the role of guarantors. But there are areas where action may be needed, such as mandatory ­individual licensing of financial planners and the separation of wealth management and the manufacture of financial products.
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They might call it prudent, the rest of us call it greed

  • 12:00AM October 2, 2018
For years you would have heard over and over, from regulators and bankers alike, how it was “strong regulation” and “prudent management” that kept our economy and financial system afloat during the 2008 financial crisis.
The 1000-page interim report of the royal commission into ­financial services skewered this self-serving narrative.
It was sheer luck that we muddled through the crisis with so little economic disruption: luck that rapid population growth ensured a growing pool of customers to fuel revenue growth.
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  • Oct 3 2018 at 4:55 PM

'Appropriate': AMP defends charging dead people, TAL says spying standard

Life insurance companies that have been exposed for charging life insurance premiums to dead customers and hiring private investigators to spy on people have defended their actions by saying that's the way it's always been.
The strident defence of practices, revealed during the sixth round of hearings at the banking royal commission, include very limited admissions of bad behaviour from life insurers including AMP, Clearview, CommInsure and TAL.
AMP does not take a backward step in its submission where it describes its process of charging dead customers life insurance premiums as "inevitable and appropriate", while laying the blame for higher default life insurance premiums charged at the same rates as smokers at the feet of policy holders themselves.
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  • Updated Oct 4 2018 at 2:00 PM

Banking royal commission interim report: How Hayne could change Australia

by Justin O'Brien
Commissioner Kenneth Hayne has prided himself on operating to a tight and demanding schedule. On September 28 he handed down the interim findings of the Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry. Mindful of its political volatility, the government provided immediate pubic release. The scale of the report, at 1000 pages across three volumes, should not overwhelm.
There is not a scintilla of padding. It is one of the most consequential royal commissions ever conducted in Australia. There is little new from an evidential perspective. The strategic use of case studies, however, highlight systemic issues that cannot be ignored at corporate, regulatory or political level. 
By concentrating on key normative failures in design and application of legislation and policy, he has brought the judiciary back in as a countervailing force. For those who need an additional prompt, the key messages are highlighted in red text. Culture, governance and conduct are essential building blocks in the creation of a new regulatory infrastructure informed by what Commissioner Hayne sees as essential principles: justice and fairness, alongside utility and efficiency.
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ABC Implosion.

Angry ABC staff weigh up 'sacking' their own board representative

By Bevan Shields
29 September 2018 — 11:45pm
Furious ABC reporters are discussing whether to effectively sack their own staff representative from the board in a new move that escalates the turmoil inside the public broadcaster and puts fresh pressure on its embattled directors to stand down.
Fairfax Media understands a vote of no-confidence against Jane Connors, a veteran employee who was elevated to the coveted staff-elected director position in May, is one option being considered by journalists and editors who want answers over the board's role in last week's unprecedented crisis.
Paul Barry says board members need to be selected based on skills and merit and not on their political bias.
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The ABC board's inability to deal with two issues at the same time will prove fatal

By Bevan Shields
30 September 2018 — 11:45pm
To appreciate the world of pain the ABC board finds itself in, it's worth having a look at the evidence. And due to some helpful carelessness, there's loads of it to examine.
The national broadcaster was plunged into crisis last Monday with the shock sacking of the floundering and unpopular managing director Michelle Guthrie. She was soon followed out the door by chairman Justin Milne, who had made extraordinary demands to have two prominent journalists fired because his mate didn't like them. That mate just happened to be Malcolm Turnbull. Who also just happened to be the prime minister.
Guthrie and Milne have left the building, but the surviving seven members of the ABC board are now quite rightly facing the firing squad.
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Parliament to consider sweeping changes to the way ABC board members are picked

By Bevan Shields
30 September 2018 — 11:45pm
An influential crossbencher will exploit the Morrison government's slim grip on power in Parliament to float a radical overhaul of the ABC board selection process, including establishing US Senate-style confirmation hearings.
In an "urgent" four-stage reform plan that would delay the appointment of a new chair and managing director at the embattled public broadcaster, Fairfax Media can reveal independent senator Tim Storer is gathering cross-party support to amend legislation that dictates how ABC board members are selected.
He has also proposed an end to political battles over the $1.3 billion annual cost of the ABC and SBS by establishing a mandatory, independent and public review of their government funding every three years.
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Public execution: the future of the ABC looks grim through a PBS lens

By Michael Idato
30 September 2018 — 12:00am
When US senator John O. Pastore walked into a senate subcommittee hearing examining a proposal for $US20 million ($A28 million) in cuts to public television in 1969, the remit from then-US president Richard Nixon was simple: there was no value in a government-funded television service.
Sitting opposite Pastore was a man named Fred Rogers, better known to millions of Americans as the host of the children's program Mister Rogers’ Neighborhood, who artfully talked not about dollars but about the way in which public television content connects with its audience.
"I'm supposed to be a pretty tough guy and this is the first time I've had goosebumps for the last two days," Pastore said. "Looks like you just earned the $20 million."
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Why last week was a good one for the ABC

  • 9:22AM October 1, 2018
All things considered, last week was a pretty good one for the ABC.
Sure, it was messy and as the Prime Minister Scott Morrison said yesterday (on the ABC) the board had “a pretty ordinary week”. But the organisation? All fine, for three reasons.
First, the wrong CEO has gone. Michelle Guthrie is a good person and a fine executive, but she turned out to be wrong for leading the ABC for an important reason, one that should inform the next appointment.
It was because she was unable successfully to lead the creation of content within the organisation or to represent, and preferably personify, what the ABC stands for, outside it, either to the public or the parliament.
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We need the ABC – it’s time it realised that it needs us

  • 12:00AM October 3, 2018
The recent struggles within the ABC are about power and control. This has been the story for the past 40 years. The names and personalities change, each dispute has its special character, but the central narrative is unchanged — how to manage rival stakeholders in Australia’s most important and public media organisation.
Reform of the ABC is the eternal yet elusive quest. The organisation is embedded in our lives, our memories, our sense of country and the world. It is eternally frustrating yet the indispensable companion. It is not just the national broadcaster but a power institution in its own right. It is driven by a strong ethos — the idea of independence as the legitimising cloak for its reporting, scrutiny and critique of the nation.
It is too big, too bureaucratic, too powerful, too impossible to control and, for all these reasons, it is the subject of perennial efforts to influence and control it. Among ABC listeners and viewers, everybody has an opinion — about what’s right, what’s wrong, what they like, what they dislike. And the government and its ministers have very strong opinions.

National Budget Issues.

  • Updated Oct 3 2018 at 8:04 AM

Australian banks adequate but not 'unquestionably strong' in S&P ranking

Australia's major banks would have to raise billions of dollars of additional capital to be in the "unquestionably strong" top quarter of the world's lenders based on a widely tracked credit rating agency measure.
In a survey of the world's 100 banks compiled by credit rating agency S&P Global Ratings, Australian banks last year experienced among the "steepest declines" in their risk adjusted capital, or RAC, relative to other major global lenders, pushing them into the bottom half of the global rankings.
That is because banks in other major economies bolstered their capital positions, while the economic risks posed by high levels of household debt and inflated property prices prompted S&P to penalise the Australian banks.
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Health Issues.

Captive in Campbelltown as patient fights to leave public hospital

By Nicole Pedersen-McKinnon
30 September 2018 — 12:10am

Talking points

  • Decisions about admissions to private versus public hospitals are made by hospitals, ambulances and doctors, says the Commonwealth Ombudsman.
  • Complaints about health facilities and providers are handled by state-based complaints organisations. 
  • In NSW that body is the Health Care Complaints Commission on 1800 043 159; in Victoria it is the Health Complaints Commissioner Victoria on 1300 582 113 or the Victorian Ombudsman on 1800 806 314; and in Queensland, it is the Office of the Health Ombudsman on 133 646.
  • If the reason a person is not admitted to a particular hospital is because of their health insurer – say, it did not confirm cover in time – they should contact the insurer’s complaints department in the first instance and the Commonwealth Ombudsman if the outcome is unsatisfactory.
Tanya Young was visiting Sydney for business, staying with a friend and enjoying her morning cup of tea when she sneezed.
“I felt this ripping pain go through my back and I started crying and went down on my knees,” she explains.
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Australian suicide numbers climb at unacceptable rate

The Australian Bureau of Statistics has released its latest Causes of Death report, highlighting that Australians are taking their lives at an unacceptable rate. The number of Australians dying by suicide is higher than ever before, with figures showing 3128 people took their lives in 2017 compared with 2866 in 2016. SANE Australia CEO, Jack Heath, said that the increase in the overall suicide rate put the nation back to where it was 2 years ago – heading towards nine Australians taking their life every day. The major results of the report include: the suicide rate increased from 11.8 to 12.7 per 100 000 Australians; there was an average of 8.6 deaths by suicide in Australia each day; there were 2348 male deaths at a rate of 19.2 per 100 000; there were 780 female deaths at a rate of 6.3 per 100 000; suicide death rates are up in the ACT, Queensland, Western Australia, the NT and New South Wales; suicide death rates are down in Tasmania, with rates remaining the same in Victoria and South Australia. “We also know that the risk of suicide is higher for those living with complex mental illness and we still have a long way to go in reducing the stigma associated with complex mental illness and in facilitating access to adequate evidence-based care and support,” said Mr Heath. “We need to work more closely with people who have attempted suicide to better understand what we can do to assist people when they need it most – it is really important that we encourage people to seek help early on.”
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Health expenditure Australia 2016–17

28 Sep 2018
Description
This report is the latest in the Australian Institute of Health and Welfare’s (AIHW) Health expenditure Australia series and includes estimates of how much was spent on health between 2006–07 and 2016–17. These estimates form Australia’s National Health Accounts. The National Health Accounts give in-depth information relating to the performance and efficiency of Australia’s health system and changes over time. They are a related (but separate) collection from the Australian National Accounts prepared by the Australian Bureau of Statistics (ABS), which cover the entire economy.
Governments driving growth
More than two-thirds (69%) of health spending is funded by the Australian Government and state and territory governments ($75 billion and $50 billion, respectively) and governments were the main drivers of the recent growth in spending. Total government spending on health grew by 6.8% in real terms in 2016–17 to $124 billion, well above the average growth rate for the previous 5 years of 2.6%.
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Cabinet kicks Medicare can down the road

  • 12:00AM October 1, 2018
Fixing the archaic Medicare, veterans and aged-care payments system — one of the most politically sensitive projects in government — will be left to whoever wins the next election.
The system is crucial to the government being able to deliver more than 600 million payments totalling about $50 billion each year. But it is beyond its use-by date and has required extensive remediation efforts and consideration of a replacement system.
Officials have repeatedly warned of a “critically high risk of system failure”, and that a new system will be required to facilitate broader health reforms. However, that would be a huge undertaking, over several years, and lesser projects have been beset by delays, breakdowns and privacy breaches.
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Nobel prize in medicine jointly awarded to two cancer researchers

By Simon Johnson & Kate Kelland
1 October 2018 — 8:29pm
Stockholm: American James Allison and Japanese Tasuku Honjo won the 2018 Nobel Prize for Physiology or Medicine on Monday for game-changing discoveries about how to harness and manipulate the immune system to fight cancer.
The scientists' work in the 1990s has since swiftly led to new and dramatically improved therapies for cancers such as melanoma and lung cancer, which had previously been extremely difficult to treat.
"The seminal discoveries by the two Laureates constitute a landmark in our fight against cancer," the Nobel Assembly at Sweden's Karolinska Institute said as it awarded the prize of 9 million Swedish crowns ($1.4 million).
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Kidney cancer therapy works but cost is a killer

  • 12:00AM October 2, 2018
Darryl Black was told he had just three months to live. That was ­almost four years ago.
The 62-year-old grandfather from Adelaide’s northern suburbs now wants others to access his lifesaving cancer treatment at an ­affordable price.
In early 2015, Mr Black became one of the first Australians to receive combination immunotherapy for advanced kidney cancer as part of a worldwide trial conducted by American pharmaceutical giant Bristol Myers Squibb.
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Cervical cancer set to be eliminated from Australia in global first

By Aisha Dow
3 October 2018 — 12:01am
Cervical cancer is set to become a rare disease in Australia within just two years and rendered so uncommon by 2028 it will be deemed eliminated as a public health problem for the first time anywhere in the world.
The new forecast has been detailed in research in the Lancet Public Health Journal, which found that although global deaths from the disease still exceed 310,000 each year, Australia is heading towards a scenario where cervical cancer would be almost unheard of.
The Cancer Council has predicts that Australia will be the first country to complete get rid of cervical cancer with the HPV vaccine.
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Couples to be tested for 500 genes linked to childhood disorders before conception

By Kate Aubusson
3 October 2018 — 12:00am
Ten thousand would-be parents will get free testing to detect about 500 genes linked to severe disorders they risk passing on to unborn children in an unprecedented trial that could radically transform family planning in Australia.
Researchers are in the process of finalising the extraordinary list of severe and deadly genetic conditions that will be included in a large-scale preconception carrier screening trial. It could start recruiting couples in the second half of 2019.
The Australian Reproductive Carrier Screening Project (ARCSP) will include spinal muscular atrophy (SMA), cystic fibrosis and fragile X syndrome. Eventually, affected couples would be offered subsidised IVF treatment.
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Medibank to publish patient feedback on hospitals

  • 9:37PM October 2, 2018
Hospitals will be judged by their patients and the results published online by insurer Medibank, with early signs the experience in the public system is not as positive as going private.
While the initiative will not go live until next month, Medibank CEO Craig Drummond yesterday said the initial data from more than 30,000 survey responses showed Australia’s health system was delivering for patients.
Medibank’s Patient Reported Experience Measures Survey covers various aspect of a hospital stay including interaction with staff, responsiveness of nurses, pain management and discharge planning. It was launched in 2016 as a quality management tool.
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Coalition accused of ‘dishonesty’ over $8m aged care ad campaign

  • 12:00AM October 3, 2018
An $8 million advertising campaign spruiking the Coalition’s aged-care budget and 20,000 new home-care packages was spent when the federal government knew older Australians could not access the support for years.
The online, print, radio and TV ads told seniors they should start planning for the future and living independently, advising them the federal government had provided “20,000 extra high-level home- care packages to help you stay at home … for longer”.
At the time of the campaign — the largest single ad spend in this year’s budget — the waiting list for home-care packages was 108,000 and rising fast. The latest update shows the nat­ional priority queue has grown to more than 121,000 people.
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Overweight patients at greater risk of post-surgery complications

  • 04 October 4, 2018
Being overweight or obese makes you more likely to need a joint replacement but also increases the risk of complications after surgery, according to new safety and quality data.
An analysis of data on the Australian Orthopaedic Association’s Joint Replacement Registry, to be released today, reveals the influence of a patient’s overall health and weight on surgical outcomes.
More hip, knee and shoulder replacements are being performed in Australia, partly due to rising obesity rates and the ageing population, however the revision rate has remained steady or improved in recent years.
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Test cases risk NDIS budget blowout

  • 12:00AM October 6, 2018
A decision to force the National Disability Insurance Agency to fund registered nurses for diabetics would blow the budget by up to $1.6 billion each year, by its own estimate, as the program loses significant cost-shifting battles with state governments and the courts threaten its viability.
More than five years after the $22bn landmark scheme began, bureaucrats remain locked in tense ­negotiations with the states and territories about who should pay for health services, transport, out-of-home care and autism services while courts and tribunals pick holes in “ill-defined” legislation.
The total value of additional costs for the scheme could top $5bn each year if the NDIA continues to lose test cases, based on estimates from the Productivity Commission, government agencies and participant data.
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International Issues.

US, Canada reach NAFTA deal

  • By Jacob M Schlesinger
  • Dow Jones
  • October 1, 2018
The US and Canada are preparing to announce a dramatic, last-minute deal on revising the North American Free Trade agreement, lifting a cloud of uncertainty over the quarter-century-old continental commercial bloc.
The pending agreement will allow Canada to join an accord reached in late August between the US and Mexico and diminishes the prospects for President Donald Trump to follow through on his threats either to kill NAFTA outright or to break the trilateral pact into separate pieces.
The surprising Washington-Ottawa accord came just four days after Mr Trump’s trade representative, Robert Lighthizer, told Congress that the gaps between the two countries appeared too great to bridge in time to meet the US-imposed Sunday midnight deadline, and that the administration was prepared to keep moving down the path of a Mexico-only agreement.
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posted on 01 October 2018

The 2018 Long-Term Budget Outlook

from the Congressional Budget Office
-- this post authored by Stephanie Hugie Barello
In June, CBO released The 2018 Long-Term Budget Outlook, the latest installment of an annual report describing the agency’s projections of federal spending, revenues, deficits, and debt over the next 30 years. This week, CBO is publishing two blog posts to share key excerpts from the report. Today’s post presents some of the report’s key takeaways.
  • In CBO’s projections, the federal budget deficit, relative to the size of the economy, grows substantially over the next several years, stabilizes for a few years, and then grows again over the rest of the 30-year period, leading to federal debt held by the public that would approach 100 percent of gross domestic product (GDP) by the end of the next decade and 152 percent by 2048 - compared with 78 percent now . Moreover, if lawmakers changed current laws to maintain certain policies now in place - preventing a significant increase in individual income taxes in 2026, for example - the result would be even larger increases in debt.
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Brexit: is Britain up to it?

The EU was hugely beneficial for Britons. They will now need to discover new strengths.

By Jenny Stewart
2 October 2018 — 12:06am
While many have questioned her leadership skills, few can doubt Theresa May's prime ministerial fortitude. In the strange schemozzle that is Britain's exit from the European Union, she, at least, is determined to "make a success of it" – if her party lets her stay the course.
The real challenge of Brexit, however, goes much deeper than the technical problems involved, difficult as these are. The case for "leave" goes to the heart of Britain's sense of itself as a nation. It is worth revisiting some of these broader-run and longer-run considerations, which seem to have been lost in the countdown to the deal-making deadline in March 2019.
After a bruising encounter with European leaders in Salzburg, British Prime Minister Theresa May says the EU needs to come up with alternatives to her Brexit plan.
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'Devastating' effects: IMF chief sends warning on trade wars

By Andrew Mayeda
2 October 2018 — 5:37am
The International Monetary Fund is poised to cut its forecast for global growth as Managing Director Christine Lagarde warns trade wars and tighter credit are darkening the outlook.
Three months since predicting the world economy would grow 3.9 per cent this year and next, Lagarde signalled in Washington that she is no longer quite so optimistic. The fund will update its World Economic Outlook on October 9 ahead of opening its annual meeting in Bali, Indonesia.
"Six months ago, I pointed to clouds of risk on the horizon," Lagarde said, according to her prepared remarks. "Today, some of those risks have begun to materialise."
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What's in sweeping new NAFTA deal between US, Canada and Mexico

By Heather Long
Updated1 October 2018 — 11:41pmfirst published at 11:25pm
Washington: On Sunday night local time, US President Donald Trump got his wish for a significantly revised North American trade deal. After more than a year of intense negotiations, the United States, Canada and Mexico reached an agreement to update the North American Free Trade Agreement, the 1994 pact that governs more than $US1.2 trillion worth of trade among the three nations.
The new deal won't go into effect right away. Most of the key provisions don't start until 2020 because leaders from the three countries have to sign it before the US Congress (and legislatures in Canada and Mexico) have to approve it, a process that is expected to take months.

New name

Goodbye NAFTA. The new deal will be known as the United States-Mexico-Canada Agreement or "USMCA." Trump, who had long disdained NAFTA, had suggested he might call it the "USMC," in honour of the US Marine Corps, but in the end, USMCA won out.
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China then and now: an investor’s guide to the key issues

  • 12:00AM October 2, 2018
What happens in China at any given time has a big effect on global business conditions and investment markets — every investor needs to understand it’s impact: But it’s a complex economy to follow, not least because China has the unusual mix of a communist government that allows private ownership of assets along with a powerful and at times interfering bureaucracy.
My first visit to China was in the mid-1960s, during that country’s “cultural revolution” when the Chinese economy was largely cut off from the world, all property and assets were under government ownership, and the middle class was small and persecuted.
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  • Updated Oct 3 2018 at 10:13 AM

Donald Trump might beat Mexico in trade war, but not China

When a country (USA) is losing many billions of dollars on trade with virtually every country it does business with, trade wars are good, and easy to win." This tweet of March 2 set out the aims and means of Donald Trump's trade policy. The apparent victory over Canada and Mexico and the signing of a new trade deal will convince him he is right. But China is not Mexico.
The US president believes if a country sells more goods to a trade partner than it buys, it has "won". He also thinks that if it buys more goods from a trading partner than it sells, it can "win" a protectionist war, because the other side has more to lose. These two convictions — bilateral mercantilism and asymmetric balance of pain — are his guides. His policy is to use the way in which the US "loses" to secure victory. Since the US is also the most powerful country in any bilateral relationship, it has to win.
Serious economists, back to Adam Smith, would insist that seeking a surplus with every trading partner is not "winning". It is absurd. This is not even intelligent mercantilism, which would focus on the overall balance. Yet, particularly with free capital flows, overall balance is a foolish goal and one that trade policy cannot achieve. It is incredible that such primitive ideas rule the most sophisticated country on earth.
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  • Updated Oct 5 2018 at 5:33 AM

China is weaponising on a massive scale, says Mike Pence

Washington | US Vice President Mike Pence has dramatically turned up the heat on China, accusing it of meddling in the November midterm elections and aggressively turning "plowshares into swords on a massive scale".
In an inflammatory speech that immediately drew condemnation from Beijing, Mr Pence detailed a litany of abuse by the Chinese Communist Party against its own citizens and the creation of an "unparalleled surveillance state" as well as religious repression against minorities.
The lashing comes as tensions on both sides of the Pacific are escalating, with President Donald Trump slamming China last week for seeking his political ouster and a report by Bloomberg News showing spies tapped almost 30 major US companies including Amazon and Apple by hiding tiny chips into critical network servers.
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  • Oct 5 2018 at 10:30 AM

US Federal Reserve interest rate hikes 'will trigger debt meltdown'

by Ambrose Evans-Pritchard
Fitch Ratings has warned that global bond markets face a rude shock as the US Federal Reserve jams on the brakes to avert overheating, with grave implications for inflated asset prices across the world.
Brian Coulton, the agency's chief economist, said investors have underestimated the Fed's determination to drain excess liquidity and prevent the inflation genie escaping from the bottle. It can no longer wait as White House fiscal stimulus drives a surge in late-cycle growth.
"When you listen to what Fed chairman Jay Powell is saying, you have to take him at his word," Mr Coulton told The Daily Telegraph.
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  • Updated Oct 4 2018 at 9:06 PM

Investors wake up and smell the populism

It says a lot about the extraordinary insularity of financial markets that investors are genuinely shocked when populist politicians push ahead and implement the big-spending promises they made in order to get elected.
Italy is the latest case in point. In elections in early March, Italians deserted mainstream parties in droves and instead got behind two anti-establishment populist parties: the maverick Five Star Movement (M5S) whose electoral campaign had featured the promise of universal basic income of €780 ($1260) a month; and the hard-right League, which promised a flat tax rate of 15 per cent.
By the end of May, the two large anti-establishment parties had managed to cobble together a deal to form a coalition government that, instead of trying to seek some type of compromise, committed to introducing the lavish promises of both partners: that is, a universal basic income scheme along unprecedented tax cuts.
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  • Updated Oct 5 2018 at 7:38 PM

Heavy seas ahead for Scott Morrison amid US, China tensions

Scott Morrison will embark on his first round of summit season next month, the annual pow-wows of world leaders in sterile convention centres in otherwise exotic locales.
For a prime minister who only reluctantly moved his family into Kirribilli on security grounds, the "ring of steel" that encircles summit venues, motorcades and the very visible presence of police and armed forces will be a potent symbol of just how quickly his fortunes turned. 
First up in mid-November is Singapore for the East Asia Summit, with the Asia-Pacific Economic Co-operation (APEC) summit in Port Moresby hard on the heels after that (in between Morrison will host Japan's Shinzo Abe in Darwin for a one-day trip). 
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With Kavanaugh's appointment, progressive America's nightmare has arrived

By Matthew Knott
6 October 2018 — 12:46pm
In Donald Trump's presidency, this may prove to be the sweetest, most consequential, victory of all.
On Saturday in Washington, Trump accomplished what has been a dream of Republican presidents for half a century: a reliable conservative majority on the Supreme Court.
Supreme Court nominee Brett Kavanaugh secures the votes needed, including a 'yes' vote from key swing Republican senators Susan Collins and Jeff Flake, as well as Democrat Joe Manchin, to be confirmed in a final vote on Saturday.
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Donald Trump's pick Brett Kavanaugh confirmed to the US Supreme Court

By Richard Cowan, Amanda Becker & David Morgan
7 October 2018 — 7:01am
Washington: A deeply divided US Senate on Saturday confirmed Brett Kavanaugh to the Supreme Court, as Republicans dismissed sexual assault accusations against the conservative judge and delivered a major victory to President Donald Trump.
By a vote of 50-48, the Senate gave a lifetime job to Kavanaugh, 53, after weeks of fierce debate over sexual violence, privilege and alcohol abuse that convulsed the nation just weeks before congressional elections on November 6.
After allegations of sexual assault and weeks of intense debate that gripped the nation, Brett Kavanaugh was confirmed as the next justice to the Supreme Court Saturday after a 50-48 Senate vote.
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I look forward to comments on all this!
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David.

The AMA Still Seems To Be Having A Bit Each Way On The #myHealthRecord. I Wonder Why?

This release appeared from the AMA last week, covering their Submission to the Senate Inquiry.

My Health Record Has Huge Potential

05 Oct 2018
In order to restore public confidence in My Health Record, it is critical that privacy issues are addressed.
That was one take home message the AMA has provided the Government in its submission to the Senate Community Affairs References Committee Inquiry into the My Health Record System.
The submission noted, however, that the additional privacy protections set out in the proposed My Health Records Amendment (Strengthening Privacy) Bill 2018, go a long way towards achieving this.
This comes as a direct result of AMA President Dr Tony Bartone securing a commitment from Health Minister Greg Hunt to fix the privacy concerns.
The Bill substantially reduces any discretion that the My Health Record System Operator has to disclose health information in the My Health Record. The limits are substantially tighter than the controls that apply under the Commonwealth’s Privacy Act 1988 to patient data stored in the clinician’s own patient records.
The AMA would like My Health Record to succeed because the clinical benefits are considerable, and it has the capacity to save lives. But the system will need to be continually improved.
The AMA’s submission notes the strengths of the system and points to potential benefits of My Health Record.
“Treating clinicians need to have access to a detailed and accurate clinical patient history to provide the best possible care,” the submission states.
“The siloed nature of the Australian healthcare system and the localised storage of patient records in their doctor’s own patient records, compromises the flow of patient information between healthcare settings, and between healthcare practitioners.
“Many of the greatest failures in patient care and safety result when patients are required to move across the health system, but their clinical information does not follow them.
“The My Health Record has the potential to circumvent these limitations to ensure clinically important patient information is available at the point of care, irrespective of the health care setting and the location of the treating doctor.
“The result is better connected care, reduced medical harm from avoidable medication complications and allergic reactions. As the My Health Record matures, and patient participation levels increase, the record may also generate health system efficiencies by eliminating diagnostic and pathology tests currently duplicated because test results are not available to the treating doctor.
“Not only is duplication wasteful, it is detrimental to the patient as duplicated tests expose them to additional radiation from X-rays and CT Scans.”
Increased patient engagement in their own healthcare is another way the My Health Record can improve quality of care, according to the AMA.
Research indicates 40 to 80 per cent of medical information provided by healthcare practitioners is forgotten immediately by patients.
“If patients have access to their clinical data in their My Health Record, they are more likely to understand their health conditions, adhere to treatment advice and engage more actively with their treating clinicians in their ongoing care,” the submission states.
“This will also assist in increasing overall patient health literacy, which will improve long-term health outcomes and indeed improve prevention and education activities.”
The AMA also points out that inclusion of patient nominated advanced care planning documents in the My Health Record increases the likelihood emergency treatments will align with patient preference if they have lost the ability to speak for themselves, or have lost decision-making capacity.
“If the benefits of My Health Record are to be fully realised, the My Health Record system will need to become self-sustaining,” the submission states.
CHRIS JOHNSON
Here is the link:
I think it is important to read these sort of releases carefully because they are part of a larger political discussion with the Government and the AMA is keen to keep its powder dry for the larger fights they need to have on practitioner payment etc.
So what do we read:
1. “My Health Record Has Huge Potential” – you wonder how they can know that but also the heading implies that right now it is not much use.
2. “The submission noted, however, that the additional privacy protections set out in the proposed My Health Records Amendment (Strengthening Privacy) Bill 2018, go a long way towards achieving this.” Doesn’t that mean they are not happy so far and more needs to be done?
3. “The AMA would like My Health Record to succeed because the clinical benefits are considerable, and it has the capacity to save lives. But the system will need to be continually improved.” Meaning the system is a fair way from where it needs to be?
4. “Treating clinicians need to have access to a detailed and accurate clinical patient history to provide the best possible care,” The #myHR is hardly the place you look for such current, accurate, detailed information. The GPs local system is far better for that!
5. “The My Health Record has the potential to circumvent these limitations to ensure clinically important patient information is available at the point of care, irrespective of the health care setting and the location of the treating doctor.” This assumes all the treating practitioners have access to the #myHR have updated it and so on. The evidence this is happening is pretty scant and without a lot of ongoing payments will almost certainly never happen.
6. “If the benefits of My Health Record are to be fully realised, the My Health Record system will need to become self-sustaining,”  I wonder what is meant here – more practitioner payments maybe? Again the benefits are all future tense.
So basically they see the #myHR  as a system which is still incomplete, unproven and needs a lot more work – associated with more payments for the practitioners to use it.
As I said this is a politically driven response that raises more issues and expresses hope not confidence.
David.

Wednesday, October 10, 2018

The ADHA Just Continue To Be In Denial Regarding The Digital Divide.

This appeared last week:

Digitising social services could further exclude people already on the margins

04 Oct 2018
Siobhan O'Sullivan and Christopher Walker
People who are most dependent on social services are also the least able to easily transition into the digital age.
Digital or e-government has been prominent on Australia’s political agenda for at least a decade. It has led to improvements in e-services that allow you to pay rates online, submit a digital tax return, or claim rebates for medical bills.
But while e-services can make life more convenient for those who have access, there are signs that transacting with the state digitally is fast becoming mandatory. The My Health Record opt-out system, for example, assumes everyone will participate in this digital initiative unless they take deliberate action to do otherwise.
Our research suggests those who will not, or cannot, engage with the state online, may find themselves without basic government services – and even more alienated from government in the future.

People are being left behind

There are many reasons why citizens may not be able to engage digitally, including poverty, digital illiteracy and lack of digital infrastructure.
Research suggests that the so-called digital divide is shrinking in Australia, with 97% connectivity among households with children under 15 years.
But the same research shows that an inability to connect digitally is fast become a very serious force for compounding social exclusion. Those who are left behind, are being absolutely left behind – the gap is narrow but deep.
The Australian Digital Inclusion Index identifies those most likely to be digitally excluded as:
  • people on low incomes
  • people aged over 65
  • people with a disability
  • people with low levels of education
  • Aboriginal Australians
  • the unemployed
  • people living outside capital cities.

Face-to-face services are shrinking

E-government is supposed to be efficient, cost effective, and according to some scholars, enhance democracy by allowing for greater interaction between citizens and the state.
But e-government isn’t only about increasing the number of ways citizens may transact with government online. It’s also moving services online that have traditionally relied upon face-to-face, empathetic and therapeutic relationships. For example, services such as those offered by the employment services sector.
To better understand the likely impact of social service digitalisation, we looked at what it might mean for people living in remote Aboriginal communities in Western Australia and the Northern Territory.
We conducted interviews with federal public servants working as e-government specialists in a number of social services and Aboriginal services portfolios. We also interviewed federal service providers, NGOs, and a representative from a private telecommunications company.

Exclusion is structural

We found a great appetite for digital connectivity among the people we spoke to. Facebook, Instagram, online banking, and online buying and selling websites such as eBay are popular among the communities we engaged.
At the same time, we found the ability to speak to a front line public servant – either face-to-face or over the phone – is diminishing. This is creating a service gap with very real and adverse impacts on the lives of some citizens. One interviewee told us:
until a couple of years [ago], you used to get your fortnightly form mailed out to you […] and you took that down to Centrelink and lodge it on its due day. Now you’re expected to remember that you’ve got to go online every second Tuesday and self-report.
And the penalties for missed engagement can be significant:
a mainstream client would have received a text message telling them that you’ve missed an appointment, please contact your provider immediately. Because our clients don’t get those text messages they don’t find out their allowance has been suspended […] until their next payment day when it doesn’t come.
It’s the people most dependent on social services, who are least able to easily transition into the digital age. In some cases, they live in a part of Australia that simply does not have internet infrastructure, and perhaps will never get it. We were told:
there’s no NBN infrastructure, and it’s not going in. One day they’ll get the satellite connections, but at the moment no-one has internet in the homes.
In other cases, there is infrastructure but maintaining digital connectivity is a personal cost that exacerbates the divide. People living in remote parts of Australia do not have a choice of providers, and that is reflected in the costs of monthly plans.
Sometimes the citizen may have access and a working device, but colonial assumptions that permeate the e-government landscape act as a deterrent to engagement. For example, one interviewee told us that when it comes to setting security questions:
they’re questions like, what is the name of the street you grew up on, which is not applicable. A lot of communities have house numbers, not street names. It’ll ask you the name of your first pet. And again, Indigenous people don’t think of the animals around as pets in the same way that we do.

It’s not getting better

Our research suggests that while digital services have great potential, that potential is yet to improve the life chances of the most vulnerable members of our community. And things appear to be getting worse. While the government is focused on e-services as an alternative way to engage citizens, the reduction of much more costly face to face services is problematic.
Our research also suggests the government is not investing the time, money and effort needed to make sure all Australian citizens are successfully transitioning to the digital world. There is a widening gap, which the not-for-profit sector is graciously filling in many communities, But our concern is while e-government may bring advantages for some, it will further marginalise those who are already seriously disadvantaged.
Supporting an individual’s transition to active digital engagement is just as important as the ongoing development of digital services. As digitalisation progresses it must bring all citizens along with it.
Siobhan O'Sullivan, Senior Lecturer in Social Policy, UNSW and Christopher Walker, Head of School, Social Sciences, UNSW
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Here is the link:
To me the key sentence is this one:
“But the same research shows that an inability to connect digitally is fast become a very serious force for compounding social exclusion. Those who are left behind, are being absolutely left behind – the gap is narrow but deep.”
Interestingly the article does not seem to specifically call out the mentally ill.
The ADHA produced a document for the Senate Inquiry.
Brief: Reaching People with Mental Health Conditions, from Australian Digital Health Agency, received 25 September 2018.
Here is the link:
Basically it is just a seven page list of all the groups of people who have been engaged / met with but somehow really feels like box-ticking rather than actual engagement with individuals.
Has anyone seen a document from the ADHA outlining its strategy for addressing the Digital Divide in the opt-out period and beyond. I have not and given it may involve a good 20% of the population it is pretty late.
David.

Further To The Apparently "Gone To Ground" ADHA CEO. - (UPDATED-1)

For myself (and others I am sure) I would like to know?

1. How long is the CEO away for?

2. When will he be back or is he working out his notice and won't be back.

3. What has been the Senate's Inquiries role in all this?

4. Why has he taken leave when the Senate Inquiry is about to report?

5. Why did we all discover about this by accident?

Here is the HITN Tweet disclosing the role.



RIP the fax: Successful secure messaging trials solve final problems, heralding a fax-free future for Australian healthcare, the ADHA's acting CEO says: http://bit.ly/2NyKFDs

Surely someone inside the ADHA can let us all know?

David.

p.s.

2:20pm. Thanks to a tweet from Ben Grubb we now know Tim is back Monday.

Ben Grubb  @bengrubb10m

The CEO of ADHA, the agency behind My Health Record, has not left, contrary to rumours on @davidmore blog (aushealthit.blogspot.com/2018/10/it-see… and aushealthit.blogspot.com/2018/10/furthe…) Per ADHA spokesperson: "Tim is on one week of approved annual leave and will be back on the weekend."

D.

I Am Not Sure The HIMSS Conference In Early November Will Be Of Much Value Or Interest In Australia.


This description arrived a day or so ago:
The 12th Annual HIMSS AsiaPac18 Conference & Exhibition is coming to Brisbane Australia!
The event will gather 1,500+ of the brightest in health and health IT across APAC and the globe: healthcare providers, C-suite leaders, government officials and solution providers. Attend and learn from the best practices, case studies and expert insights on the latest in digital health and information technology.
Themed Healthcare Anytime, Anywhere, HIMSS AsiaPac18 has something for everyone! We look forward to welcoming you in Brisbane this November. 
Curious I wondered when and found:
Seems it is happening 5-8 November with the main days being 6 and 7 November.
I wonder did they notice the second day was the First Tuesday in November (Melbourne Cup Day)?
The programme for the 2 main days stuck me as rather lacking much local content and being rather military of all things on Tuesday.
Then I looked at the sponsors:
Top of the tree I found:
Thought Leader Sponsor:

The Australian Digital Health Agency

The Australian Digital Health Agency was established in July 2016 to improve health outcomes for all Australians with a focus on engagement, innovation and clinical quality and safety. It is responsible for national systems – including My Health Record – and for implementing Australia’s National Digital Health Strategy in collaboration with partners across the community. The Strategy will put consumers at the centre of their health and care and empower more choice, control and transparency. By the end of 2018, all Australians will have a My Health Record, which contains a secure mobile summary of their health information that can be shared with care professionals – unless they choose to opt out.
For more information please visit www.digitalhealth.gov.au
I am also not sure I could handle a presentation from the Consumer Health Forum titled 'Healthcare Transparency and Co-Creation with Consumers". Rather too Orwellian for me...
Here is the conference link:
Well that did it for me, especially with an expired security certificate and especially with the cost being over $1000 for the two days: Pass
The HINZ one for less money sounds like more fun:

HiNZ conference growth shows digital health has hit the mainstream

5 October, 2018
eHealthNews.nz editor Rebecca McBeth
Clinicians are the biggest driver in the growth of the HiNZ Conference, with the 2018 event expected to be the biggest yet, says HiNZ chief executive Kim Mundell.
Around 1000 delegates are expected at this year’s HiNZ Conference, running from Wednesday 21 November to Friday 23 November.
The event, held at Wellington’s TSB Arena and Shed 6, will also boast its largest ever exhibition hall, with 93 booths.
Mundell says the growth of the conference year on year shows that digital health has moved out of the early adopter stage and into the mainstream.
Clinicians in particular are fuelling the growth in delegate numbers, she says.
“It’s no longer a niche subject that you have a few clinicians engage with – it’s now mainstream and part of everyday healthcare.”
Twelve international keynote speakers from the UK, US, Brazil, Hong Kong and Australia will speak on topics ranging from digitising patient records to artificial intelligence in healthcare and the role of smartphones in cancer research.
Keynote speaker Richard Corbridge was the former CIO of the Irish Health Service Executive and was named in 2017 as the “most disruptive tech or digital leader” in the European Union by Sir Richard Branson and Steve Wozniak.
He says an electronic health record is the key to efficiency and transparency and the only way a healthcare system can be integrated.
“Ireland was the first country in Europe to present a business case for a digital health system that included not just the traditional IT cost but also the cost of business change – the cost of ensuring not just the technology was procured, but that the cost of ensuring benefit gained was figured into the project,” he says.
“The citizens of New Zealand deserve a modern healthcare system that is built upon information. The ability to return information about patients to them to aid with their own health and wellness should be a modern expectation of the health system.”
Fellow UK-based keynote Lesley Holdsworth is the Scottish Government’s clinical lead for digital health and care and has been named both Scottish Digital Impact Leader of the Year and UK Digital Team Leader in 2018.
She is driving digitisation of Scotland’s patient records and benchmarking it against global frontrunners and says New Zealanders should embrace their medical records going digital, not fear it.
“There are many benefits to us all as both patients and citizens of having EHRs. These include ensuring that information about us is accurate, up to date and can be easily shared with both us and those who need to have this information,” Holdsworth says.
The HiNZ conference also includes a one-day eHealth Nursing and an eAllied Health event.
Here is the link:
As they say, you pay your money and take your chance…
David.

It Seems The ADHA Has An Acting CEO At Present!

It has been confirmed to me today that, as of a day or so ago, Ms Bettina McMahon is the "Acting CEO" of the ADHA as Mr Kelsey takes some leave. This follows him having spent a good deal of time in the UK in the last few months.

A bit of an odd time to be taking leave with the Senate Inquiries into the #myHealthRecord reporting in the next week or so..

Anyone know what is going on? Is this a holiday or gardening leave?

You can see the title used in this article on the dreaded fax!

https://www.healthcareit.com.au/article/rip-fax-successful-secure-messaging-trials-solve-final-problems-heralding-fax-free-future

Comments welcome!

David.