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, January 17, 2019

The Macro View – Economics, and Politics and the Big Picture. News Relevant To E-Health And The Health Sector In General Among Other Things.

January 17, 2019 Edition.
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There is only one issue in the US this week and that is the shutdown which is just dragging on and on and is already the longest ever.  Just how it is going to be resolved is not clear as both sides appear to be entrenched in the positions regarding the wall!
Big week in the UK. What happened with the vote was 400 to 200 or so - a huge defeat. We have no idea what happens from here, especially now that the Government has retained confidence. What next, who knows.....
In Australia the summer stupor rolls on and not much seems to be happening. I wonder what comes after the cane-toad bounty proposal? Inter-Alia ScMo is wandering around the South Pacific selling out importance vis a vis China. Good luck with that!
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Major Issues.

If we want a better, kinder society, it needs to start with us

By Amanda Vanstone
6 January 2019 — 11:59pm
As the international cricket and holiday season finish and the new year cranks up we focus on the year ahead. Archie Schiller, the kid who got to wear the baggy green at the Boxing Day Test, reminds us that courage and determination are admirable human qualities. If a seven-year-old can face sustained difficulty with dignity and can see the good in life despite the problems ahead surely we could all follow his example. Archie had his courage, dignity and enthusiasm for life long before he got a baggy green.
Being enthusiastic about the good in life doesn’t mean ignoring the bad. But when you only look at the darkness you won’t see the light. Seeing the light is another way of describing hope.
Hope for a decent life, for a better world. Without hope, there’s nothing. The Italians have a saying: “La speranza e l’ultima morire.” Hope is the last to die.
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In poor countries income does trickle down

By Ross Gittins
7 January 2019 — 12:00am
Try this test of your economic literacy: has world poverty decreased or increased since 1990? If you said decreased, congratulations. You’re smarter than the average bear.
If you were sure it had increased, you’re the victim of a news media gone overboard in indulging your preference for bad news over good.
A lot of bad things are happening in the world, but also some really good things, and we immiserate ourselves when we fail to give them the notice they deserve.
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Armed build-up means a space war may no longer be in the realm of imagination

By John Hemmings
Updated6 January 2019 — 9:07pmfirst published at 1:24pm
The news that China has landed an explorer robot on the dark side of the Moon has echoed across the global media, a sign of the country's growing prominence on the international stage. There is something rather fascinating about China – a non-Western global power – making the achievement. It feels like a turning of the page.
Western powers have dominated modern economics, sciences and political ideologies for so long they implicitly set standards for what marks a civilised power. Space exploration remains a benchmark.
The Chinese government has sought to draw attention to the robot Moon landing, celebrating it as a step forward for China and for all mankind. However, while the rise of its space programme is a positive development, it comes at an odd time in China's history, a moment when the country seems beset by historic contradictions and tensions.
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Buyers hit the brakes on new car sales last year

By Nick Toscano
4 January 2019 — 4:51pm
Australians pumped the brakes on buying new cars last year, as a tightening of bank lending controls and the impact of the slowing property market drove a drop-off in new vehicle sales, automotive industry leaders have said.
Sales of new cars across the country declined for the first time in four years, according to data released by the Federal Chamber of Automotive Industries on Friday, which showed 1,153,111 vehicles were sold in 2018 compared to a record year of 1,189,116 sales the previous year.
The 2018 figures, representing a 3 per cent drop, were the result of a “challenging year” for the industry, FCAI chief executive Tony Weber said.
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Has the stock market established a bottom? Not so fast

By Mohamed El-Erian
7 January 2019 — 10:44am
The January 4 monster rally in risk assets, which saw major US stock indexes surge by 3 per cent to 4 per cent and the "risk-free" yield on 10-year US Treasuries rise by 11 basis points, was a stark illustration of the power of a favorable alignment of the trifecta of economic fundamentals, central bank liquidity and technical factors. Whether markets have reached the bottom of what has been a brutal few months for investors is, however, a much more complicated and uncertain question.
The strong employment data released early January 4 ensured a solidly higher open for markets. Not only did the economy create 312,000 new jobs in December, or almost twice the rate of consensus expectations, but wage growth also picked up (to 3.2 per cent annually), and revisions bolstered the October and November jobs tallies.
Concerns that the latest report would push the Federal Reserve into a more hawkish policy stance were offset by another encouraging component in the monthly data: a rise in the participation rate (from 62.9 per cent to 63.1 per cent), which indicated there is a further element of slack in the labour market
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Local firm AEV Robotics plugs into demand for electric car modules

  • 12:00AM January 7, 2019
An Australian firm plans to start assembling lightweight, modular electric cars locally by 2021.
AEV Robotics said the vehicles consist of a common robotic base that supports a purpose-built module that sits on top. One version of the car could operate ride-sharing with driverless operation while others could be geared to deliver goods, waste management and medical services.
The local start-up said it had been working in secret for more than three years on developing the modular system, which it plans to market globally.
Chief executive Julian Broadbent said the vehicles were ­designed to be slow-moving in built-up urban areas.
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Check how much your stock is undervalued

07 Jan 2019 — 11:00 PM
Investors looking for stockmarket bargains could well start with Chanticleer's analysis of the top 100 companies ranked by the percentage discount to the consensus share price targets of the country's leading broking analysts.
The analysis reveals that many quality companies with good prospects in sectors of the economy that should do well in the year ahead are trading at huge discounts to the consensus earnings estimates of brokers.
The data prepared for Chanticleer by S&P Capital IQ suggests that the Australian sharemarket has been oversold in many sectors. Share prices, in many cases, bear no resemblance to the earnings prospects of leading companies.
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S&P 500 could still be 14.5pc overvalued: NAB

Updated 08 Jan 2019 — 9:04 AM, first published at 4:07 AM
The S&P 500 could still be as much as 14.5 per cent overvalued, and that could keep the Federal Reserve on the sidelines through the first half of 2019, according to NAB.
NAB market strategist Tapas Strickland said the recent sell-off "has seen valuations come back more in line with fair value" based on several market metrics used traditionally to judge whether the stock market is expensive or cheap.
In early October Mr Strickland wrote that stocks then were found to be between 13 per cent and 27 per cent overvalued on a cyclically adjusted P/E ratio (CAPE) basis.
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Property prices can be like an unexpected drought for small business

07 Jan 2019 — 11:00 PM
Falling Australian house prices could soon have the same effect on thousands of small businesses that drought had for farmers, and the ramifications could be disastrous for an economy in its 28th year of growth.
A small business selling car tyres in Melbourne's inner south might be running a reasonably profitable operation, but there are now early signs that such a business owner, who has used his or her home as security, could face problems when seeking to rollover the business loan.
House prices have fallen 10.5 per cent in Melbourne's inner south over the past 12 months, according to Corelogic, so when the bank does a valuation on the home in order to rollover the small business loan – it is going to require the debt to be reduced.
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How to dodge a market dip that threatens your retirement

By Tara Siegel Bernard
Updated 08 Jan 2019 — 1:39 PM, first published at 1:31 PM
You've heard it before: when the markets become erratic, or even poised for a prolonged downturn, the best thing you can do is nothing at all.
But if you are on the cusp of retirement — or perhaps worse, newly retired — a turbulent stock market can make you feel particularly vulnerable.
While there is some validity to those feelings, it's more productive to redirect any panic into prudence, which will help ensure your money lasts longer.
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Retailers stuck as shoppers stay home

By Bo Seo
Updated 08 Jan 2019 — 3:36 PM, first published at 3:24 PM
Retailers are scrambling to avoid a "liquidity crisis" after in-store foot traffic fell 8 per cent between Black Friday and Boxing Day, compared to the prior year.
"Foot traffic appears to have been weak as shoppers continue to shift December shopping trips online and pull forward purchases into Black Friday in November," said Citi in a note reviewing the past Christmas season.
Citi said that discounting had not increased, and in some cases retailers had pulled back after "several years of discounting ramping up to unsustainable levels in some categories".
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Markets are flashing warning signs of a corporate profit collapse

By Lu Wang
Updated 09 Jan 2019 — 10:04 AM, first published at 9:45 AM
Everyone knows profit growth is poised to cool this year. But by how much? Analysts who try to answer that question by looking at signals embedded in the stock market are coming up with some worrisome numbers.
Going by history, the 16 per cent decline in the S&P 500 between Sept. 20 and Jan. 3 reflected investors pricing in better-than-even odds of an economic recession in 2019 and a 9 per cent decline in earnings, JPMorgan strategists led by Nikolaos Panigirtzoglou wrote in a note. Another approach, the dividend discount model, suggested markets anticipate annual profit growth of 3.7 per cent through 2023, according to Goldman strategists led by David Kostin.
Either is a far cry from the consensus estimate of individual stock analysts, who as of Friday predict earnings in the benchmark will rise 7.7 per cent this year. And both are a major downshift from the 20 per cent-plus increase companies will post for all of 2018.
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World Bank cuts growth forecasts for global economy

By Andrew Mayeda
Updated 09 Jan 2019 — 9:39 AM, first published at 9:38 AM
The World Bank cut its forecast for the global economy as slowing growth in trade and investment and rising interest rates sapped momentum, especially in emerging markets.
Downside risks to the world economy have become more acute, including the threat of "disorderly" market movements and an escalation of trade disputes, the development lender said Tuesday in its semi-annual update to its global outlook.
Debt vulnerabilities in emerging markets and developing countries have increased, it said.
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Kate Samranvedhya: The best asset class that barely anyone owns

By Kate Samranvedhya
08 Jan 2019 — 11:00 PM
When looking back at asset performance in 2018, it is a great reminder that bonds should play a major role in an investment portfolio, and that not all bonds are created equal.
At the beginning of 2018, all anyone wanted to talk about was how it was going to be a great year for equities and a bad year for bonds because the Federal Reserve (the Fed) was raising interest rates and inflation was about to arrive. Popular trades were to be long equities, long corporate bonds, and long inflation-linked bonds. Alas, global growth peaked in the first quarter of 2018. By year end, oil slumped 25 per cent and killed inflationary fears.
According to Bloomberg, in 2018, major global equity markets returned negative 6 to 25 per cent, global aggregate credit negative 3 per cent, global inflation-linked negative 4 per cent, and global high yield negative 4 per cent. You may find this puzzling, but the US Treasury Bond index delivered a positive return of 0.9 per cent, despite the Fed raising interest rates by 1 per cent. This is government bonds performing exactly the way a defensive asset is supposed to; it diversifies risk when the rest of your portfolio struggles.
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Ten years of bitcoin is about more than boom, bubble and bust

By Stephen Bartholomeusz
8 January 2019 — 12:38pm
This weekend will mark the 10th anniversary of the very first transaction involving bitcoin. A decade later the future of bitcoins and the host of the so-called cryptocurrencies that it spawned is still uncertain.
On 12 January 2009, someone who called themselves Satoshi Nakamoto sent 10 bitcoins to a US software engineer, Hal Finney (they may, some believe, have been one and the same). The coins were virtually worthless and it took more than two years before the first exchange of bitcoins for goods – 10,000 bitcoin for two pizzas worth about $US30 ($42) – occurred.
For most of their history cryptocurrencies have been a curiosity, a peer-to-peer anti-establishment version of digital cash that was more of a concept than a functioning currency.
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Low income earners forgotten in Labor's franking credit plan

By Deborah Ralston
09 Jan 2019 — 11:00 PM
It has been suggested that the Labor policy initiative to remove refunds on excess franking credits is really a return to the original dividend imputation introduced by Paul Keating in 1987. As a consequence, this is a "truer and fairer" system than shareholders have enjoyed since 2001, when excess franking credits became refundable.
Is that really the case though?
The whole purpose of dividend imputation is to prevent the double taxation of dividends. For individual investors the company pays the tax up front and then shareholders claim against this "imputed tax" or withholding tax when they file their tax return. The franking credits are added to taxable income, and the taxpayer then pays tax at the marginal rate on their total taxable income (including dividends and franking credits). The franking credits are then deducted from the tax liability.
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Ocean warming faster than thought, new research finds

By Kendra Pierre-Louis
11 January 2019 — 9:37am
Washington: Scientists say the world's oceans are warming far more quickly than previously thought, a finding with dire implications for climate change because almost all the excess heat absorbed by the planet ends up stored in their waters.
A new analysis, published on Thursday in the journal Science, found that the oceans are heating up 40 per cent faster on average than a UN panel estimated five years ago. The researchers also concluded that ocean temperatures have broken records for several straight years.
"2018 is going to be the warmest year on record for the Earth's oceans," said Zeke Hausfather, an energy systems analyst at independent climate research group Berkeley Earth and an author of the study. "As 2017 was the warmest year, and 2016 was the warmest year."
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Scott on the rocks: Six signs it's all going south for Morrison

By Madonna King
10 January 2019 — 12:55pm
Scott Morrison’s government is in free fall.
And it’s beyond imagination to conceive that it can claw its way back to the Treasury benches, post election.
The proposal by Home Affairs Minister Peter Dutton of a public register of child sex offenders is just another example of a desperate politician, in a desperate government, performing a desperate stunt.
A national register of convicted sex offenders offers serious merit, and could provide parents with enormous confidence. Indeed, many child advocates strongly endorse the idea.
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Silicon Valley’s trough can help reboot Australia’s start-ups

CHARLOTTE KENNEDY and WILL SCHMITT
  • 12:00AM January 11, 2019
Silicon Valley’s “tech bro” dystopian excesses were laid bare last year for the world to see. In short, consumers and regulators weren’t ­impressed.
The year started with Mark Zuckerberg awkwardly shifting in a chair in front of multiple US congressional hearings regarding Facebook’s role in enabling Russian interference in the 2016 ­presidential election and the social network’s problematic data and privacy practices. User data was shared inappropriately or hacked across many platforms, including at Google. The year ended with the tech giants’ stock prices plummeting, with Apple, Google parent Alph­abet and Amazon all down more than 20 per cent on the year.
While Silicon Valley’s tech giants largely have sidestepped the ire of consumers and citizens to date, it seems that a significant backlash is brewing against their excesses, particularly regarding breaches of privacy and trust. People reportedly are removing the Facebook app from their phones at a steady clip (including 44 per cent of American 18 to 29-year-olds).
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Economy to weather the storms

  • 12:00AM January 12, 2019
The Australian economy is mostly expected to weather recent sharp falls in property and shares, although broader growth is set to fall short of last year’s pace.
As the new year begins, the ­nation’s top economic forecasters are largely unfazed by the pre-Christmas sharemarket jitters that saw US shares join most global bourses in bear markets — defined as falls of at least 20 per cent.
Similarly, the fastest year-on-year fall in the housing market since the global financial crisis is expected to be manageable after a record boom in the past decade, with economists expecting peak-to-trough average falls in Sydney and Melbourne of 10-20 per cent at worst.
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Seeds have been sown for recession in next two years

  • 12:00AM January 12, 2019
If there’s a recession in Australia in 2019 or 2020, or if it feels like one, the causes will be traceable back to two things that happened in 2014: the recommendation from the Senate Economics References Committee for a royal commission into financial services and the final report of Murray Inquiry.
The first occurred in June that year, and was prompted by the ABC’s Four Corners program on May 5, called “Banking Bad”, which exposed the corrupt sales culture within Commonwealth Bank’s financial planning division. The Murray report landed on Sunday, December 7.
It’s a bit hard to decide which was more important, but I think the impact of the Financial System Inquiry chaired by David Murray on today’s economy has been greater than the royal commission — just.
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People not as well off as they think, new study reveals

By Stephen Miles
13 January 2019 — 12:00am
Australians may not be as well off as they think they are, a new study into the financial wellbeing of thousands of bank customers has found.
The study used a survey of more than 5600 Commonwealth Bank customers together with observations made from their banking data.
It reveals 9 per cent self reported they were "having trouble" managing their finances. However, in reality, 17 per cent were observed to be finding it tough to meet monthly expenses.
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Voice referendum must trump republic plebiscite, Aboriginal academics insist

  • 12:00AM January 12, 2019
Bill Shorten’s proposal for a ­republican plebiscite faces an assault from prominent indigenous figures who are calling on Labor to dump the policy and focus on establishing an indigenous voice to parliament.
Leading indigenous academics Megan Davis, Marcia Langton and Eddie Synot say the campaign for an indigenous voice should be given clear air.
The Greens are also urging Labor to dump a first-term plebiscite on the republic, along with Maritime Union of Australia Northern Territory branch secretary Thomas Mayor.
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Financial Services Royal Commission Issues.

ACCC warns 'arrogant' business sector of huge fines

06 Jan 2019 — 11:45 PM
Competition regulator Rod Sims has slammed the corporate sector as arrogant and warned companies that mislead consumers to expect fines in the hundreds of millions of dollars this year.
A fired-up Mr Sims also predicted the Australian Competition and Consumer Commission will increasingly clash with companies over merger proposals, and accused dealmakers of lying about wider benefits of potential takeovers.
The ACCC chairman said the Hayne royal commission into misconduct in the financial services sector and other scandals had exposed the business community for losing focus on their customers.
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Productivity Commission super report: Retail funds face 'rough justice'

Updated 10 Jan 2019 — 10:11 AM, first published at 12:00 AM
Retail funds will likely see greater outflows this year after a damning report by the Productivity Commission that comes on top of the tarnished image of the for-profit sector from the Hayne royal commission.
The Productivity Commission's final report into the superannuation system released on Thursday found a significant number of super products were underperforming and that "most (but not all) affected members are in retail funds".
The report found 77 per cent of 5 million underperforming super accounts were in retail funds, despite retail funds representing just 9 of the 29 funds the commission had identified as underperforming.
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Productivity Commission super report: 31 recommendations take aim at APRA, ASIC

10 Jan 2019 — 12:01 AM
The Productivity Commission has released a major report into Australia's superannuation system. These are its recommendations.
  1. Employees should only ever be defaulted into a superannuation account if they are new to the workforce or don't have an existing account.
  2. Employees without a superannuation account should be presented 10 "best in show" funds to choose from within 60 days. If no choice is made after that time they will defaulted into one of these 10.
  3. The "best in show" super funds shortlist will be judged by an independent expert panel to ensure they deliver the best outcomes for their potential members.
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Productivity Commission super report: SMSFs with less than $500,000 perform poorly

Updated 10 Jan 2019 — 10:08 AM, first published at 12:00 AM
Self-managed superannuation funds with less than $500,000 perform "significantly worse" on average than regular funds, the Productivity Commission says.
The commission previously named $1 million as the point at which SMSFs tend to be broadly competitive with industry and retail funds.
But in its final report to government and after further modelling, the commission has revised the figure downwards to $500,000.
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Productivity Commission super report: Cleaning up the $2.7tn super industry

10 Jan 2019 — 12:00 AM
One of the deeply shameful industry secrets exposed by the Hayne royal commission was the shabby complicity between major financial institutions and super fund trustees that resulted in millions of people being trapped in high-fee, poor-performing legacy superannuation products.
Large financial institutions, of course, were obviously loath to move customers out of these high-fee accounts because to do so not only would shrink their own fee revenues but could upset their tied financial advisers, who were still allowed to pocket trailing commissions from these long-standing accounts, even after such commissions were banned after 2014.
Meanwhile, it was dismaying to see how trustees — who are supposed to act in the interests of super fund members — were so easily swayed by the arguments of the financial firm that offered the product.
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Superannuation overhaul presented to government could add $500,000 to some accounts

By Shane Wright
10 January 2019 — 12:01am
Australians entering the workforce would be up to $533,000 better off in retirement under plans handed to the Morrison government that would weed-out scores of under-performing superannuation funds and force regulators to focus on the interests of consumers.
In its final report into the superannuation system, the Productivity Commission argues people in their mid-50s stood to gain up to $79,000 in retirement from changes that would put both the industry and retail sectors under increased scrutiny and competition.
Treasurer Josh Frydenberg talks about the final report by the Productivity Commission into the efficiency and competitiveness of Australia's superannuation system.
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Sort super, then tackle an even bigger retirement problem

By Shane Wright
10 January 2019 — 12:01am
The Productivity Commission has delivered a wide-ranging final report to the Morrison government that, if correct, could deliver billions of dollars worth of benefits to Australians.
Its findings around account duplication, lack of competition, "zombie" insurance policies that eat account balances rather than brains and the way many in the superannuation industry worry more about themselves than their customers are compelling.
Treasurer Josh Frydenberg talks about the final report by the Productivity Commission into the efficiency and competitiveness of Australia's superannuation system.
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The far from super truth about our retirement system laid bare

By Stephen Bartholomeusz
10 January 2019 — 12:15am
The Productivity Commission’s inquiry into the efficiency and competitiveness of the superannuation system doesn’t really tell us much more than its draft report last year or that anyone familiar with the system didn’t know. That doesn’t, however, diminish the significance of its insights or recommendations.
The broad conclusion is that, while the system performs quite well when benchmarked against retirement savings systems elsewhere, it isn’t as efficient or competitive as it could be and, while on average the system performs well, the below-average parts of the system perform poorly indeed.
The two key points the PC has highlighted are that there are too many unintended multiple accounts in the system – about a third of all accounts, or about ten million -- and too many entrenched under-performers.
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National Budget Issues.

Paris Agreement to shrink economy, says US’s Brookings Institution

  • 12:00AM January 9, 2019
Australia’s economy will be among the worst affected by the Paris climate change agreement, enduring slower growth, fewer jobs and a “notable” 6 per cent slump in the exchange rate, ­according to a new analysis of the global accord.
The report by the Washington-based Brookings Institut­ion also finds the treaty will fail to cut carbon emissions on 2015 levels or put the world on a path to keeping global temperature rises to 2C or less.
The co-ordinated push to save the planet from climate change will shrink the economy by about 2 per cent and sap household wealth by 0.5 per cent by 2030, even if Australia chooses to back out of the agreement, the report found.
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Australian economy starts year on a sticky wicket

  • By James Glynn
  • 12:00AM January 9, 2019
The new year has only just begun but the economic data in Australia is starting to cause worry, with consumers already glum due to falling house prices, volatile share­markets and even a poor performance by the nation’s cricketers.
The ANZ-Roy Morgan weekly survey of consumer confidence gauge showed a fall of 2.2 per cent to 115.2 points early this month from the prior week, with a clutch of negative news probably feeding the downbeat mood.
David Plank, ANZ’s head of Australian economics, cited broad weakness in equity prices since the previous confidence survey in December.
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Franking credit change could wipe billions from banks: Citigroup

By Shane Wright & Samantha Hutchinson
Tens of billions of dollars could be wiped from the value of Australia's big four banks because of Labor's plan to end cash refunds for excess franking credits with Citigroup analysts warning the policy is a "significant issue" for the financial sector.
In research which argues Labor's separate policy of restricting negative gearing to new properties will only have a "muted" impact, Citigroup researchers found its target valuations of the nation's major banks could fall by up to 13 per cent in the wake of the franking credit change.
Labor plans to overhaul the dividend imputation system, ending the process introduced by the Howard government under which shareholders without a tax liability can receive a cash refund on excess franking credits.
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Slowing economy puts budget surplus in doubt, Fitch Ratings warns

Updated 09 Jan 2019 — 2:02 PM, first published at 11:29 AM
A slowdown in the world economy will soften anticipated federal revenues and may force the government to spend more to support Australia, stopping the Morrison government reaching its much-hyped return to a budget surplus next year, economists at Fitch Solutions have predicted.
Fitch, a global macroeconomic consulting firm, issued a report on Wednesday forecasting relatively small budget deficits of 0.3 per cent of GDP for 2018-19 and 0.1 per cent of GDP next financial year.
It painted a slightly less rosy outlook than the government's December mid-year budget update, which forecast a small deficit of $5.2 billion (0.3 per cent of GDP) this fiscal year and a much-heralded surplus of $4.1 billion (0.2 per cent of GDP) in 2019-20.
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November retail sales show solid growth, ABS reports

  • By James Glynn
  • January 11, 2019
Australian retail sales grew solidly in November with consumers, likely attracted by aggressive price discounting late in the month, easing fears of a broad slowdown in spending that threatens to slow the economy sharply.
Retail sales rose by 0.4 per cent in November from a month earlier, the Australian Bureau of Statistics said on Friday, compared with a 0.3 per cent rise expected by economists.
The better-than-expected outcome reflected strong demand for household goods, clothing and footwear. Sales for October weren’t revised.
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The Australian dream died alone in an apartment

By David Fickling
12 January 2019 — 1:11pm
For people in the US, the American Dream is a vision of broadly shared prosperity, freedom and opportunity. Xi Jinping's Chinese Dream focuses on rising incomes and national renewal.
Australians once had a simpler aspiration: owning a detached suburban home on a quarter-acre of land. That vision died a while ago.
Back in the 1980s, single-family detached homes comprised about three-quarters of building approvals, and even through the 1990s and 2000s the proportion was still around two-thirds.
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Health Issues.

A gentle pinking': news reports glorify dangerous sun exposure

By Kate Aubusson
7 January 2019 — 5:00am
Australians are being told to abandon sun safety messages by media reports that glorify sun exposure and tout dangerous fads such as 'a gentle pinking’.
The public may love a sunburnt country but mixed messages in news reports is skewing the balance between the serious harms of ultraviolet radiation and the benefits of vitamin D, a new analysis shows.
The researchers at UNSW and Notre Dame University analysed 211 articles published in Australian newspapers containing the terms ‘skin cancer’, ‘vitamin D’ and ‘melanoma’ between 2000 and 2017.
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Doctors push autonomy at Healius in shadow of takeover

By Mathew Dunckley
7 January 2019 — 12:04am
The army of general practitioners working at Healius clinics around the country will be looking for commitments around clinical autonomy from any new owner of the ASX-listed health giant.
Chinese company Jangho Group on Thursday unveiled a $2 billion bid for Healius and its network of 2500 health centres around the country including general practise, pathology, radiology and other services.
The Healius board said last week it was assessing the offer and its conditions. A further announcement from the company is expected as soon as Monday morning. The company declined to comment on Sunday.
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Healius rejects takeover bid from Chinese investor Jangho

By Patrick Hatch
7 January 2019 — 9:57am
Health group Healius has rejected an almost $2 billion takeover bid from its largest investor, the Chinese group Jangho, saying it "fundamentally undervalues" the company.
The bid from Jangho, which already owns almost 16 per cent of Healius, landed on Friday last week, catching investors and the company by surprise.
Healius said on Monday that the bid of $3.35 a share was opportunistic.
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MBS Review: Its 7-point plan for general practice

Proposals include funding patients to enrol with their practice
7th January 2019
The MBS Review Taskforce has finally released its draft plan for general practice, with proposals to introduce major reforms to GP management plans and a call to cut the funding for medication reviews.
After two years of closed-door deliberations, and months of leaks and rumours, GPs and the wider public have been given a first full look at the recommendations from the review’s general practice and primary care committee.
Below, we list the main reform suggestions:
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MBS Review: Draft blueprint for care plans revealed

Medicare task force releases long-awaited report on the future of GP MBS funding
7th January 2019
GP consults for MBS care plans will have to last at least 40 minutes under a proposed shake-up by the Medicare Review Taskforce.
After months of speculation, the task force's primary care expert committee released its draft blueprint for reform, which includes MBS payments for “GPs and practices” to formally enrol patients.
It also suggests finally scrapping item 723 for team care arrangements, with patients offered access to subsidised allied health services triggered via the GP management plan item 721.
The aim is to reduce duplication and pointless paperwork.
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Lifestyle diseases likely to boost medicines bill, say Fitch analysts

  • January 8, 2019
The nation’s medicine bill is likely to spike over the next five years as an increasing number of Australians suffer from lifestyle-related diseases, Fitch analysts say.
The increasing prevalence of lifestyle-related illness in Australia, combined with an aging population, is likely to cost as much as $15.8 billion in medicine consumption by 2022, sharply up from $13.2bn in 2017, the ratings agency said.
That increase equates to a five-year compound annual growth rate of 3.7 per cent.
Still, Fitch analysts said that for drug makers operating here, the environment remains challenging, as the listing of high-value pharmaceuticals on the Australian Pharmaceutical Benefit Scheme remains difficult and pricing pressure grows.
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Headspace gets another $47m in funding

Youth mental health organisation headspace has had its funding boosted by the federal government for the third time since October.
Australian Associated Press January 9, 20197:42am
Young people who have experienced mental health issues will tour Australia sharing their stories as part of a $47 million funding boost to headspace.
The head office of the youth mental health organisation - which runs 107 support centres for young people nationally - will get the bulk of the funding over the coming three years.
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Accused Medicare rorters hit back as department unites with police

  • 12:00AM January 9, 2019
Doctors and other providers accused of misusing Medicare are refusing to repay the money and even using the same lawyers to “game the system”, the Department of Health has been warned.
The Australian yesterday revealed the department was working with police on a test case to seize the assets of Medicare rort­ers and demonstrate it was not a “soft enforcer”.
The use of the Proceeds of Crime Act, normally associated with drug traffickers and fraudsters, would represent a fundamental shift in Medicare compliance operations.
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Fentanyl ‘epidemic’ a deadly threat

  • 12:00AM January 10, 2019
Australia is at risk of a relentless wave of US-style fentanyl deaths unless governments embrace law reform that prioritises education and harm minimisation above punitive law and order responses, a leading campaigner has warned.
David Stanley, who was a driving force behind Melbourne’s medical-supervised injecting centre, has warned that an influx of fentanyl in epidemic proportions is distinctly possible, given Australia’s huge borders and its growing popularity among traffickers who substitute the substance in heroin without telling users.
He said Australia should seriously consider scrapping penalties for personal drug use, creating a threshold level where people were given health, treatment or education options rather than facing the full weight of the law.
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Christian lobbyists target Medical Board's draft code of conduct

They claim it is pro-intervention for transgender patients
10th January 2019
Christian lobbyists are claiming doctors who refuse treatment for gender dysphoria could end up sanctioned under the Medical Board of Australia’s proposed update to the Code of Conduct.
Groups opposed to gender reassignment have targeted the current consultation on the good practice code, objecting to a new section that states that doctors should not impede patient access to care based on gender identity or sexual orientation.
There is also a reworked section on culturally safe care, which says: “Only the patient and/or their family can determine whether or not care is culturally safe and respectful.”
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Australia has the highest rates of infection by an HIV-like virus, but no one cares

By Jill Margo
11 Jan 2019 — 11:00 PM
The world is waking up to an ancient virus that has silently been causing despair and premature death among people who don't know they have it.
While Central Australia has the world's highest rates of infection with this virus, it also exists globally in other disadvantaged communities. Because of the ease with which people now travel and the accelerated rate of human migration, awareness of the virus is slowly growing.
The virus can cause a range of complications regarded as mysterious simply because people have never heard of it. These complications are sometimes confused with premature ageing. It's called HTLV-1 which stands for the Human T-cell lymphotropic/leukaemia virus type 1 and is a cousin of HIV which causes AIDS. Because HTLV-1 is less virulent and has not yet hit wealthy urban areas in significant numbers, it has been largely ignored.
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Hospital billing review abandoned

  • 12:00AM January 12, 2019
The states have abandoned their bid to challenge federal evidence of public hospitals “harvesting” privately insured patients, paving the way for federal Health Minister Greg Hunt to pursue long-­debated reforms.
Public hospitals bill more than $1.1 billion in treatment to health insurers each year, offsetting costs that would normally have to be covered under state budgets.
Pat­ients are even offered private rooms and other perks to be treated privately.
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Health insurance system is slowly falling apart

By Crispin Hull
12 January 2019 — 12:00am
The health-insurance system (public and private) is slowly parting at the seams and the government’s “reforms” due in April are more likely to make patients angrier rather than mollify them.
High specialists’ gap fees; the GP squeeze; health insurers’ profiteering and inefficiency; and the flight of people from private health insurance are the key problems, and they are all related.
Government policy, of course, must bear a lot of the blame. Interestingly, one policy – lifetime health cover – which was designed to bolster private insurance, now appears to be having the opposite effect.
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Ringing in the new year aged care conversation

By Barbara Drury
13 January 2019 — 12:15am
As families get together to celebrate and relax over the summer holidays it can also be a time when the realisation hits that elderly parents and grandparents are no longer coping living on their own.
So how do you start what is often a difficult conversation?
Prime Minister Scott Morrison has announced the royal commission into aged care will report back to the government by April 2020 and conduct a wide-ranging investigation into the future of the scandal-plagued sector.
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International Issues.

Theresa May has 10 days of turbulence to save deal

  • By Tim Shipman
  • The Times
  • 11:42AM January 6, 2019
Contemplating a return from the festive break, one cabinet minister was short on Christmas spirit last week: “The next few weeks are going to be hideous.”
When MPs disappeared a fortnight ago, Theresa May’s aides had hoped that a period of reflection would encourage more Tories to support her Brexit deal in the vote, already delayed, due on January 15.
“The hope was that MPs would go home and consume much milk and honey and return with a different perspective. But that doesn’t seem to have happened,” one of May’s team conceded. Another said: “The people with Brexit indigestion are still dyspeptic.”
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Don't underestimate the political instincts of Donald Trump

By Ian Bremmer
06 Jan 2019 — 11:45 PM
Donald Trump enters 2019 locked in a fierce political battle with new House Speaker Nancy Pelosi, a fight he will lose. He can't force Democrats to apportion money for a wall between the United States and Mexico, but influential conservatives in media threaten to punish him if he retreats. He'll eventually find a way to surrender while declaring victory. And then his year will become even more complicated.
Trump's 2019 "to-do" list is formidable, even by presidential standards. He must help restore confidence in the US economy after three months of the worst US stock market meltdown in many years, and he must accomplish this at a time when global economic growth is beginning to look soft.
He must reassure the world that the United States and China are not on a course toward endless trade conflict or a Cold War-scale military confrontation while addressing the genuine security concerns of those who believe China continues to take advantage of the United States, its companies, and its workers.
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Theresa May prepares for vote on her Brexit deal and it doesn't seem a winner

Updated 07 Jan 2019 — 8:10 AM, first published at 8:03 AM
Prime Minister Theresa May admits Britain will be in uncharted territory if her Brexit deal is rejected by Parliament later this month, despite little sign that she has won over sceptical lawmakers.
Britain is scheduled to leave the European Union in 81 days - on March 29 - but May's inability so far to get her deal for a managed exit through parliament has alarmed business leaders and investors who fear the country is heading for a damaging no-deal Brexit.
May said the vote in parliament would be around January 15, as expected, contrary to reports she could delay it. She has already delayed the vote once, in December, when it became clear she would lose unless extra reassurances from the EU were agreed.
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Brexit is not unprecedented

By Stephen Holt
7 January 2019 — 12:00am
On Thursday, June 5, 1975, whilst a student of history at Edinburgh University, I was one of the 17,378,581 enlightened souls who voted yes to sustain the United Kingdom's continued membership of the Common Market and of the European Communities (the precursor of today's European Union).
Four decades later , on another Thursday, June 23, 2016, the people of the UK, in another referendum, voted in favour of leaving the European Union. Brexit carried the day.
As a confirmed Australian by now the details of Brexit - the options, the timing, the technicalities, the politics - are beyond me. Its intricacies involve a distant land of which I am not a citizen.
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Ukrainian Orthodox Church breaks away from Russian influence

By Ayse Wieting
6 January 2019 — 1:48pm
Istanbul: An independent Ukrainian Orthodox church has been created at a signing ceremony in Turkey, formalising a split with the Russian church it had been tied to since 1686.
The Ecumenical Patriarch of Constantinople, Bartholomew I, signed the "Tomos" in Istanbul in front of clerics and Ukrainian President Petro Poroshenko on Saturday, forming the Orthodox Church of Ukraine.
It forces Ukrainian clerics to pick sides between the Moscow-backed Ukrainian churches and the new church as fighting persists in eastern Ukraine between government forces and Russia-backed rebels.
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The case for the impeachment of one Donald Trump

By David Leonhardt
Updated 07 Jan 2019 — 9:31 AM, first published at 9:19 AM
The presidential oath of office contains 35 words and one core promise: to "preserve, protect and defend the Constitution of the United States." Since virtually the moment Donald Trump took that oath two years ago, he has been violating it.
He has repeatedly put his own interests above those of the country. He has used the presidency to promote his businesses. He has accepted financial gifts from foreign countries. He has lied to the American people about his relationship with a hostile foreign government. He has tolerated Cabinet officials who use their position to enrich themselves.
To shield himself from accountability for all of this and for his unscrupulous presidential campaign he has set out to undermine the American system of checks and balances. He has called for the prosecution of his political enemies and the protection of his allies. He has attempted to obstruct justice. He has tried to shake the public's confidence in one democratic institution after another, including the press, federal law enforcement and the federal judiciary.
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The US multinational lobby is losing its voice in Washington

By Edward Luce
07 Jan 2019 — 11:54 AM
It used to be said that what was good for General Motors was good for America. Donald Trump's administration believes that what is bad for Apple is bad for China. Which means it is good for America.
When Apple's iPhone sales undershoot, as they did last week, China suffers. Or so the theory goes. In practice, they have been switching to smartphones made by Huawei, the domestic telecoms company, which may help China. But that is beside the point. What is bad for some of America's biggest brands is apparently good for its president.
It is hard to overstate the departure from how US presidents normally behave. Yet the clout of the most powerful US business lobbies was in decline before Mr Trump took the job. He has only crystallised this. Groups such as the Chamber of Commerce, and the Business Roundtable, complain loudly about Mr Trump's immigration crackdown, his tariff wars and government shutdowns.
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We can't spend out our way out of the next recession

By Kenneth Rogoff
Updated 07 Jan 2019 — 12:47 PM, first published at 11:50 AM
If you ask most central bankers around the world what their plan is for dealing with the next normal-size recession, you would be surprised how many (at least in advanced economies) say "fiscal policy". Given the high odds of a recession over the next two years – around 40 per cent in the United States, for example – monetary policymakers who think fiscal policy alone will save the day are setting themselves up for a rude awakening.
Yes, it is true that with policy interest rates near zero in most advanced economies (and just above 2 per cent even in the fast-growing US), there is little room for monetary policy to manoeuvre in a recession without considerable creativity. The best idea is to create an environment in which negative interest-rate policies can be used more fully and effectively. This will eventually happen, but in the meantime, today's overdependence on countercyclical fiscal policy is dangerously naive.
There are vast institutional differences between technocratic central banks and the politically volatile legislatures that control spending and tax policy. Let's bear in mind that a typical advanced-economy recession lasts only a year or so, whereas fiscal policy, even in the best of circumstances, invariably takes at least a few months just to be enacted.
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Why is Apple losing iPhone sales? It comes down to price and Huawei's the winner

By Raymond Zhong
Updated 07 Jan 2019 — 8:49 AM, first published at 8:37 AM
Beijing | To a lot of people, the names are unfamiliar, maybe a little hard to pronounce: Huawei, Xiaomi, Oppo, Vivo.
They are China's biggest smartphone brands. Around the world - although not in the US - they are making the handset business brutally competitive. Last week, after Apple warned of disappointing iPhone sales in China, industry observers said that devices from the Chinese brands were a major culprit.
As the phone market in China reaches saturation and sales shrink overall, the country's hardware makers are pushing hard, and increasingly winning fans, in places like France, Germany, India and Southeast Asia, where consumers find that the phones can do just about everything an iPhone can do at a fraction of the cost.
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Damage will be widespread if Beijing trade talks fail

By Stephen Bartholomeusz
7 January 2019 — 12:28pm
The stakes in the two days of face-to-face trade negotiations in Beijing between the US and China that start on Monday are substantial, and not just for the US and China.
While a failure to agree when US deputy trade representative Jeff Gerrish meets his Chinese counterparts probably wouldn’t result in a ‘’mutually assured destruction’’ outcome for the world’s two largest economies it would inevitably produce mutually assured damage with, because they are the world’s two largest and most important economies, significant spill-over effects for the rest of the world.
Donald Trump has correctly identified the fact that China is vulnerable in these negotiations, with its economy weakening.
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The dystopian view: Is this the year the world falls apart?

By Ambrose Evans-Pritchard
8 January 2019 — 10:55am
This is the year that mounting hammer blows to the Western alliance system and the edifice of global governance threaten to bring the old order tumbling down.
"The geopolitical environment is the most dangerous it's been in decades," warns Eurasia Group, political risk-adviser to the world's elites, and a voice of globalist ideology.
Pax Americana is unravelling. The transatlantic concord underpinning the West since the Fifties is dying. Nato, the G7, the G20, the WTO and the EU are all in varying degrees of crisis. Vladimir Putin's Russia has an open goal. "Every single one of these is trending negatively. And most in a way that hasn't been in evidence since the Second World War," it said.
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Middle Eastern power order at stake when US troops pull out of Syria

By Dave Sharma
8 January 2019 — 12:00am
US President Donald Trump’s December announcement that 2000 US troops stationed in Syria would withdraw within 30 days set off a wave of out-sized consequences.
It prompted the resignation of his Secretary of Defence, Jim Mattis, as well as his special envoy for the anti-ISIS coalition, Brett McGurk.
Senior US Republicans, such as Senator Lindsey Graham, were highly critical, urging Trump to reconsider his decision.
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Why the world economy feels so fragile despite relative stability

09 Jan 2019 — 9:54 AM
Should we be concerned about the state of the world economy? Yes: it always makes sense to be concerned. That does not mean something is sure to go badly wrong in the near future. On the contrary, the world economy seems to be heading into just a mild cyclical slowdown. Far more important is the adverse longer-term structural and cyclical context because it makes any short-term swing far more perilous.
According to Goldman Sachs, the momentum of global economic growth slowed markedly in 2018. The most globally significant slowdown has been in the Chinese economy— the main engine of global growth since the financial crisis of 2007-08. But Germany and Japan also recorded economic contractions in the third quarter of last year. Stock markets have also been in turmoil. In part, that presumably reflects worsening perceptions of prospects. These falling markets should also weaken consumption and investment.
All this suggests a cyclical slowdown is on the way. Yet conventional forecasters are hardly unduly worried. The OECD stated last November that the "global expansion has peaked" and that global gross domestic product growth is "projected to ease gradually from 3.7 per cent in 2018 to around 3.5 per cent in 2019 and 2020, broadly in line with underlying global potential output growth". This would be an ultra-soft landing. Consensus forecasts support this: the December consensus forecasts for growth in 2019 are little different from those made a year ago. Growth prospects for the US are even slightly upgraded.
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The real US national emergency is the threat of Trump's collapse

By Greg Sargent
9 January 2019 — 6:06am
Washington: President Donald Trump appears to be moving closer to declaring a national emergency to build the wall he craves on the southern border.
Whether or not he does this, the idea that we face such an emergency is his central public case for the wall, and so his commitment to this notion is a key reason we're embroiled in a government shutdown, with all the damage it is doing.
But if you read between the lines of all the coverage, it is overwhelmingly clear that the real national emergency that Trump and his allies have discerned is an emergency that threatens him.
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US President Donald Trump urges wall funding to fix border crisis in TV address

Updated 09 Jan 2019 — 2:09 PM, first published at 1:24 PM
WASHINGTON | President Donald Trump has used his first televised address from the Oval Office to declare a humanitarian crisis on the US-Mexico border but stopped short of triggering an official national emergency that may have freed up resources from other government sources to build a wall.
Seeking to galvanise jittery Republicans in Congress who are facing mounting pressure over a lengthening government shutdown, Mr Trump appeared to soften his approach on the border issue, which he described as a "crisis of the heart and a crisis of the soul".
Democrat refusal to support Mr Trump's demands for $US 5.7 billion ($8 billion) for the wall he promised supporters in the 2016 presidential election has led to a partial government shutdown which is now in its third week. Mr Trump's critics say he has overblown the security risks on the border and has himself worsened the humanitarian situation.
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The Ineffable Hulk, Trump is always one temper tantrum from disaster

By Michael Fullilove
11 January 2019 — 12:00am
You have to hand it to Donald Trump. He has remarkable verbal agility, even if he seems to combine it with functional illiteracy. For several years President Trump has dismissed all criticism as "fake news", a catchy phrase that has undermined the free press in America and has now been adopted by dictators around the world.
Last month he riffed on that reference, tweeting about the "Fake News Universe" in which CNN and others dwell. The universe in which Trump himself seems to dwell is not the Fake News Universe, but the Marvel Cinematic Universe. It is a mad world of extreme danger, ridiculous plot twists and ludicrous characters. And of all the Marvel characters, The Donald is especially reminiscent of The Hulk.
The Hulk is the destructive green alter ego of Bruce Banner, a mild-mannered nuclear scientist. When Bruce Banner gets angry, he transforms into a super-sized raging monster. No one is accusing Trump of being a nuclear scientist. However, before he took office many believed his Hulk-like characteristics could be controlled.
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She's playing Brexit chicken, but May is no suicide bomber

By Gwynne Dyer
11 January 2019 — 12:00am
There’s no need to practise bleeding, as the soldiers say, but the British government didn’t get the message. On Monday, it paid 89 truck drivers £550 ($930) each to simulate the immense traffic jam that will happen in Kent if Britain crashes out of the European Union without a deal at the end of March.
The drivers had to bring their vehicles to Manston, a disused World War II-vintage airfield in Kent, where the government is planning to park 4000 big trucks if a "no-deal Brexit" on March 29 leads to new customs checks on trucks heading for Europe. Every extra two minutes’ delay at customs, say the experts, would mean another 15 kilometres of trucks backed up on the roads leading to the cross-Channel terminals.
So the drivers parked their trucks on the airfield, then drove down to the port in convoy while the traffic-control experts measured ... what? This wasn’t the 10,000-truck gridlock jamming the roads that might happen in late March. It was a single file of 89 trucks driving sedately along an uncrowded road. It looked like an exercise in pure futility, a Potemkin traffic-jam.
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Maduro’s mates may yet help save Venezuela

THE ECONOMIST
  • 12:00AM January 11, 2019
Under Venezuela’s constitution, presidents are supposed to be sworn in before the National ­Assembly. But the ceremony that will begin Nicolas Maduro’s second six-year term, planned for this morning, is to take place at the ­Supreme Court.
That is because the opposition-controlled assembly regards Maduro’s election last May as a farce and his second term as illegitimate. The nominally independent court, by contrast, remains an obedient servant of the regime. The change of venue is a characteristic ­manoeuvre by Maduro, who is keeping power by increasingly dictatorial means.
That’s his one talent. After a catastrophic first term, Maduro is arguably the world’s least successful president. But the seeds of disaster were planted by his predecessor, Hugo Chavez, who died in 2013. An eloquent populist, Chavez thought the best way to help the poor was to ramp up government spending while throttling markets. He seized private businesses, imposed price controls, borrowed lavishly and sacked competent managers at PDVSA, the state-owned oil firm that is Venezuela’s main source of currency, for not supporting him ­politically.
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Donald Trump right to consider declaring national emergency in bid to pay for border wall

  • 7:46AM January 11, 2019
Donald Trump is right to seriously consider declaring a national emergency as a way of paying for his border wall and ending the US Government shutdown.
There are problems with such a dramatic move but as things stand, it is the only foreseeable way to leapfrog the deadlock between the Democrats and Trump and end the increasingly damaging federal shutdown.
Declaring a national emergency would allow Trump to bypass a gridlocked Congress and obtain his $5.7 billion for the wall via Pentagon defence funds rather than linking it as a condition of a funding bill to reopen the federal government.
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Saudi teen detained in Bangkok granted asylum in Canada

12 January 2019 — 4:25am
Bangkok: An 18-year-old Saudi woman who fled alleged abuse by her family is on her way to a new life in Canada, a Thai immigration official says.
Rahaf Mohammed Alqunun boarded a Korean Air flight from Bangkok to Seoul late on Friday night before catching a connecting flight to Canada, the head of Thailand's immigration bureau, Surachate Hakparn says.
Canadian Prime Minister Justin Trudeau has confirmed Canada has granted asylum to Saudi teen Rahaf Mohammed al-Qunun, who feared her family would kill her.
"Canada has granted her asylum," General Surachate said on Friday evening.
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I look forward to comments on all this!
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David.

Wednesday, January 16, 2019

The UK Seems To Be Moving In A Different Direction With Shared Records And Digital Health. Very Interesting I Believe.


A short while ago I heard about the Dorset Care Record from a colleague who remarked that they seemed to be setting up a small myHealthRecord for the local area – which seems to cover a population of about 700,000 souls.
The top line summary is here:

Welcome to the Dorset Care Record

Dorset Care Record (DCR) is an electronic record linking health and social care information from Dorset General Practices (doctors’ surgeries), Borough of Poole CouncilBournemouth Borough CouncilDorset County CouncilDorset County Hospital, Dorset Healthcare University NHS Foundation Trust, NHS Dorset Clinical Commissioning Group (CCG)Poole Hospital, and Royal Bournemouth and Christchurch Hospitals to improve care in Dorset.
Here is the link:
Here is how the system is described:

About the DCR

At present, health and social care organisations in Dorset may hold different sets of records about you. Information in different records may be duplicated or incomplete. The Dorset Care Record is a new confidential computer record that will, over time, include a range of health and social care shared information to help improve the care you receive.
Sharing appropriate information electronically to a single place, will offer direct access for authorised health and social care professionals to provide as full a picture as possible of your history, needs, support and service contacts. It will join records and systems together for the first time in Dorset. In the longer term, the aim is to offer you access to your record.
It is closely linked to the Dorset Information Sharing Charter (DISC), which provides Dorset partner agencies with a robust foundation for the lawful, secure and confidential sharing of personal information between themselves and other public, private or voluntary sector organisations that they work, or wish to work in partnership with. The Charter will enable all partner organisations to meet their statutory obligations and share information safely to enable integrated service provision across the county and better care outcome for its residents. Information about DISC can be found at https://www.dorsetforyou.gov.uk/disc
DISC members include GP surgeries, partners, blue light services and a range of voluntary organisations and schools. The DISC will enable all partner organisations to share information safely and provide a more integrated service for residents.
The Dorset Care Record is a key digital tool of the Dorset Integrated Care System (ICS), also known as Our Dorset, an initiative that drives sustainable transformation in health and wellbeing for Dorset residents. This service is designed to provide care closer to home, prevent ill health and reduce inequalities.

Access

By law, everyone working in, or for, the NHS and adults’ and children’s social care must respect your privacy and keep your information safe. The Dorset Care Record is held on a secure computer system. Data protection is taken very seriously. We will ensure that your record is only viewed by professionals who need to see it when providing your care.
Under the Data Protection Act (2018) and the General Data Protection Regulation, you are able to ask to see any information held about you. If you wish to see the information held about you please contact the organisation who is providing your care or the DCR Privacy Officer.

Benefits

There are a number of benefits from linking health and social care records for you. These include:
  • Co-ordinated and safer care
  • Clear decision about your care
  • No need to repeat your details to different professionals
  • Your care record is always available
  • We always have accurate contact details
  • Co-ordinated care around your needs
  • Understanding your situation better
  • Your record travels with you around the county.
The Dorset Care Record will make a big difference for health and care professionals, giving them a common, comprehensive view of your history and needs at the touch of a button. There will be no need for a series of phone calls or delays in seeking additional information. They will have a much better chance of preventing avoidable health problems, reducing hospital admissions and ensuring you receive exactly the right kind of care and support you need.
The Dorset Care Record benefits for social care include:
  • Help to improve hospital discharge planning
  • Inform support and care management in the community to help keep you independent
  • Time saved searching for information and understanding the situation when you first contact social care
  • Helping you keep well and out of hospital and understanding when you have been admitted to hospital so that home care visits can be stopped.
Other benefits include:
  • Time savings from trying to find out who is involved with you and your family
  • Ability to understand the timeline of interventions across services/organizations
  • A way to share significant events/changes in your situation with other professionals
  • Better access to information to inform decision making.

Information sharing

We are working to improve your experience of integrated health and social care. In order to achieve this, we are making care records available to health and social care staff in line with current legislation – the General Data Protection Regulation (GDPR) and Data Protection Act 2018.
The GDPR gives us lawful reasons to process your personal information, so we don’t need your consent. You can find out more about these lawful reasons by looking at the DCR Privacy Notice.  Your health and social care professional can talk to you about how your information is shared and tell you how you can opt out of the DCR if you want to.
Opting out will not affect your treatment, but the DCR will make information sharing quicker, easier and more complete, which helps to get you the right treatment at the right time, especially in an emergency situation. More details about your information rights can be found on the Information Commissioner’s Office website

Data sharing

A range of information will be shared with professionals through the Dorset Care Record:
  • Your up to date personal contact details and care needs
  • List of diagnosed conditions – so health or social care professionals have a complete record of your care
  • Medications – so everyone treating you knows what medicines you’ve been prescribed
  • Allergies – to make sure you aren’t given medicine that might give you an adverse reaction
  • Test results – to speed up your treatment and care
  • Referrals, clinic letters and discharge information – to make sure the people caring for you have all the information they need.
Under the Dorset Care Record, medical and social care professionals will be able to access the same information. They will be able to share it safely, helping make better decisions more quickly and efficiently. This will help provide you with better healthcare.

Opt out

If you do not want your health and care information to be shared, you can opt out of the Dorset Care Record. Opting out of the DCR means that your information will be hidden and not available in the DCR system even in an emergency situation unless you change your mind.
We are sharing information to improve care, but there are four ways you can opt out. You can:
  • Compete the online form
  • Print and complete the form and post it to the Privacy Officer, Dorset Care Record Partnership, County Hall, Colliton Park, Dorchester, Dorset. DT1 1XJ
  • Fill in the opt out form on our generic leaflet (Ref: DCR2/18), which can be found in public libraries, GP surgeries, hospitals and local authority buildings.
  • Call the Privacy Officer on our helpline number 0345 2000 0026
If you have previously opted out of a health and social care record, you will need to contact the appropriate provider should you wish to continue to opt out of their system.
If you have any specific concerns about your privacy you can contact the Privacy Officer on 0345 200 0026 or dcrprivacyofficer@dorsetcc.gov.uk.
Here is a technical description of the system and what it does:
Basically this is a professional use system, which from the view of the user is read-only from the most current data, and is accessible for all professionals from doctors and nurses to social care workers and ambulance staff. As yet the patient has no access but that is said to be planned.
The system is based on Orion Technology integrated by Accenture it seems (remind you of something?)
The following from medConfidential explains the current Local Health and Care Record (LHCR) initiatives,

More detail than you (probably) ever wanted to know about Local Health and Care Record systems.

The Exemplars
Five LHCR Exemplars have been chosen, covering 40% of the population of England.
While some areas will be attempting to make two or more existing (or developing) systems ‘interoperate’, in order that patients’ and service users’ data flows correctly along care pathways, it appears others may instead scrap what’s already in place / under development and commission a new system instead. While this latter approach may address (some) data flows within that area, it does not tackle what purports to be the purpose of the exemplars, which is to demonstrate functional interoperability across / between disparate systems – most acutely, across the interface with social care (an aspect which, as ever, seems very poorly represented).
Will the LHCRs be yet another round of spending on established, well-trodden shared health record technologies – in preparation for making patients’ data more readily available for a range of secondary uses – or will they instead tackle the strategic and systemic failings of (consensual, safe and transparent) information flows within and across the health and care system?

System C & Graphnet Care Alliance

Of the five Local Health and Care Record Exemplar areas, three contain at least one shared record system based on Graphnet’s CareCentric software – meaning the lowest common denominator of mass copying may predominate.
Whether it is wise to award an effective monopoly to a single supplier remains to be seen; the NHS has taken pains to avoid this is in other areas. That Graphnet’s software and just as crucially, its architectural approach – seems to be the platform underpinning the majority of the LHCREs suggests similar pains would be sensible, if only to ensure legitimate alternatives to mass data copying are properly explored.
Of course, if the political goal is to proceed at pace via ‘data ponds’ to NHS England’s Data Lake, and/or to convert these ‘Hubs’ into Data Trusts for further exploitation, then it might be sensible to come clean as soon as possible. Hiding such plans from the public is unlikely even to go as well as the care.data programme in 2013-16 (RIP).
1)  Wessex LHCRE proposes to ‘merge’ the Hampshire Health Record (HHR), that has been using Graphnet’s CareCentric software for well over a decade – and that was recently renamed the ‘Care and Health Information Exchange’ (CHIE) – and the Dorset Care Record.
The long-standing problems with HHR are well-documented, and continue despite the re-branding to CHIE. From Southern Health NHS Foundation Trust’s Board Papers, 27/3/18: “We recognise that CHIE does not yet offer clinicians an optimal view of care records nor work seamlessly with all existing clinical systems and so we will be upgrading the functionality of the system in May 2018.”
We note the CareCentric-based CHIE/HHR was adopted by the Isle of Wight in May 2018, and shall watch with close interest to see whether the mess that is HHR means it will be retendered. For now, as this PowerPoint presentation strongly suggests – cf. both “5 purposes of information sharing” slides, and the Architecture diagram on slide 13 – any new or developed system will be steeped in NHS England’s Data Lake thinking.
The Dorset Care Record signed a £7.8 million 5-year framework contract with New Zealand firm Orion Health in April 2017, part funding of which came from NHS England’s Integrated Digital Care Fund. Orion’s Rhapsody Integration Engine takes a fundamentally different approach to that of CareCentric – based on use of APIs, including FIHR, and message exchange – that could achieve interoperability without mass data copying. Media coverage relating to Rhapsody-based shared records programmes elsewhere in the country suggests close attention will be necessary (Orion’s Rhapsody platform was recently sold to private equity firm Hg Capital.)
Wessex LHCRE (as does TVS) falls under South, Central & West CSU, which – along with a number of its local CCGs – has suffered persistent Information Governance problems, documented in an extensive list of related NHS Digital Data Sharing Audits, that have included multiple breaches of agreement with NHS Digital, and not being able to determine who is a data processor and who the data controller in joint projects!
Until such basic principles have been properly established, it would seem extremely unwise to begin using (pre-GDPR definition “anonymised”) patients’ data for, say, Commissioning purposes
– as per the second bullet point in the Editor’s Notes of NHS England’s announcement of the Wessex LHCRE. Mixing secondary uses with direct care was the root cause of Manchester’s DataWell’s collapse; there is no reason to expect the same will not occur elsewhere if other secondary uses are introduced by fiat.
2)  Thames Valley and Surrey LHCRE combines a number of systems or programmes at varying stages of development, including Milton Keynes University Hospital’s Health Information Exchange, Oxfordshire’s Cerner Toolkit-based Digital Population Health Plan, and Buckinghamshire’s My Care Record - which, though incredibly poorly communicated (e.g. the patient FAQ is buried on the CCG’s website), is at this stage using Graphnet’s CareFlow Connect service for viewing patients’ GP records, as well as CareCentric for other purposes.
Berkshire’s ‘Share Your Care’ programme, that went live in January 2018, is delivered using a computer system called Connected Care, also built on Graphnet’s CareCentric software. The development of Connected Care was led by South, Central & West CSU, which has been shown to have serious Information Governance problems over a number of years.
For example, as detailed in data sharing audits by NHS Digital in November 2016, then August 2017 and a follow-up in November 2017, investigations of SCWCSU and related CCGs uncovered that not only did it process individual-level patient data outside the EEA for nearly two years – a “major breach” (para 2, p2) of its Data Sharing Contract with NHS Digital – but that it continued to do so for almost a year after it had been informed this was happening.
In addition to the breach itself, the CSU had performed no risk assessment of this (item 1, p4); data provided by NHS Digital did not even appear in its information asset register (final para, p6); it did not formally record the intended purpose of data use, or the structure, definition and means of data collection (item 4, p4); and agreements between the CSU and CCGs were not even clear who was the data controller and who was the data processor (item 3, p7)!
The Surrey Care Record, scheduled to be launched on 29 August 2018, is based on Patients Know Bests software. According to South, Central and West CSU’s Surrey Heartlands plan, both the “Roadmap” (see slide 6) and “Architectural approach” (slide 5) for Surrey show an intended “Enterprise Data Warehouse” design, with access for purposes beyond direct care by “Decision Support” as well as “Data Analysts/Scientists” clearly indicated. It is unclear how these secondary uses will satisfy PKB’s public promises about control and transparency for patients on how their records are accessed. This may not follow the best practices we have laid out, and which some suppliers have emphasised elsewhere.
With some of these systems so recently launched, or yet to be launched, it is difficult to tell how well they will all interoperate in practice. The overall intended LHCR approach, however, is quite clearly to copy all data to a CareCentric-provided “Analytics Repository” (see Connected Care Vision, slide 7) from where it may be made available for purposes beyond direct care. It remains to be seen how claims on this slide – that such detail-rich, individual-level linked data can be “anonymised”, and that “explicit consent” will be sought for all uses “outside direct care” – will be delivered in practice.
(This LHCRE may also be of particular political interest, as it is the one that covers Theresa May’s as well as other senior Ministers’ constituencies...)
3)  Greater Manchester LHCRE would appear to be based on some sort of combination of CareCentric and DataWell – though the Information Governance review of the latter in 2017 appears to have been so bad, the programme and public links to it have almost entirely disappeared. (DataWell previously existed in the Connected Health Citiesworkstream of the Health e-Research Centre at the University of Manchester, which is also the parent entity of the relevant AHSN.)
Somewhat oddly, given this 2017 statement, that also identifies DataWell’s original technology partners: “The exchange has been built by AHSN on a software platform from US company LumiraDx and working with IBM and EY (formerly Ernst & Young). “There is no central data warehouse,” Thew said. “DataWell is an information exchange and data moves at the point of need.” - UKA Health and Care, 12/7/17
DataWell was however, just 10 months later, being referred to as some sort of ‘data cleansing tool’: “Parts of Greater Manchester already use a system called CareCentric by Graphnet, which the remaining areas will also be adopting. CareCentric works by connecting different systems and sharing information between them. An existing tool called DataWell will also be used to cleanse the data, removing duplication and errors.” - University of Manchester, 24/5/18
DataWell was predicated on the mixing of direct care delivery with secondary use (research), an approach that was/is unsupportable in what must first and foremost be a shared care record. From a technical perspective – given mixing was a choice, not a necessity – this may prove to have been unfortunate; according to public statements such as the UKA Health & Care one above, DataWell used APIs and ‘just in time’ information, as opposed to CareCentric’s mass data copying approach.

Roll your own’ / other suppliers

4)  The One London LHCRE has merged (as of 5/3/18) the Local Care Record in Bromley, Lambeth and Southwark with a system called Connect Care in Bexley, Greenwich and Lewisham. We are aware there are a number of LHCR “demonstrators” across London, but confine our comments to information that is actually public at this point.
While almost no information appears to be publicly available on the technical side of Connect Care, or its governance, the ‘Skunkworks’ of the Academic Health Sciences Centre, King’s Health Partners, that is behind the Local Care Record – an organisation now known as KHP Online – has given an outline of the LCR’s development path from the initial linking of three hospital Trusts (from CSC’s old iSoft software to Advanced Health and Care’s CareNotes) through to integration with GP systems (primarily EMIS Web, but also other providers through Healthcare Gateway’s MIG).
KHP Online appear to be taking an API-based, not data copying, approach – incrementally adding in systems and services, while maintaining its primary focus on the information necessary for the provision of care.
Lacking any further detail on Connect Care, it is not possible to determine the approach it takes – nor which approach to shared care records will be adopted across South London. It is to be hoped the transparency of what One London is doing will significantly improve as the Exemplar proceeds. It may be that a fresh digital approach, fully focussed on user needs, can deliver a modern consensual, safe, and transparent model that others, most notably Graphnet, have entirely failed to deliver. It could also go very badly wrong.
5)  Yorkshire and Humber LHCRE already includes the Leeds Care Record and Rotherham Health Record. The Yorkshire & Humber Academic Health Science Network (AHSN) took the opportunity of the awarding of LHCRE status in June 2018 to announce a new collaborative, the ‘Yorkshire & Humber Digital Care Board’, that “will result in the creation of a new Yorkshire & Humber Care Record”.
This may or may not conflict with ongoing plans for the Leeds Care Record – based on Leeds Teaching Hospitals NHS Trust’s in-house electronic health record, called PPM+ – which was approved for a further 3 years development in January 2018. The Leeds Care Record has previously worked with suppliers including Healthcare Gateway (for MIG), InterSystems HealthShare (for its Master Patient Index) and PI CareTrak (for social care).
Meanwhile, Rotherham’s Electronic Patient Record (EPR) infrastructure was, once again, “overhauled” in April 2018. Rotherham NHS Foundation Trust has stuck with Meditech EPR / Healthcare Information System (HCIS) for many years – backed up by BridgeHead Software, partnering with Dell, for “data and storage management” – despite serious issues that required the intervention of Monitor in 2013, and several subsequent updates.
A December 2017 paper detailing Rotherham Health Record’s Privacy Impact Assessment and Information Sharing Agreement suggests (p8 of 43-page PDF): “The RHR portal receives data only from existing Systems and does not retain any clinical patient information locally within theportal”, which, while appearing consistent with the data flows indicated on p11, does not address exactly what the RHR portal is and how it operates – or whether data is being copied elsewhere.
We note the ISA does makes it clear (section 4.3, p27) that, for the RHR, “‘Direct care’ does not include research, teaching, financial audit, service management activities or risk stratification.” Will secondary users instead simply ‘route around’ the portal and access the BridgeHead/Dell data store directly? Much more clarity is required.

Summary

For each of these systems, the devil is in the detail. We have previously outline the principles behind such systems.
As with all care systems, it is not just what they do today, but what NHS England wishes them to do tomorrow. Once GP data has been copied into these systems, it is under the control of NHS England and available for purposes beyond direct care. This loophole needs to be closed by a clear guarantee to each patient when introducing such systems, and as part of any future NHS legislation for ACOs (ICPs) that loophole removed.
medConfidential
August 2018
Here is the link:
So what we have overall is a lot of interesting activity using all sorts of approaches on a small scale to discover what can work and be useful.
Fascinating that while the Dorset record is opt-out there are 5 consent levels. Totally out, totally in, time limited consent and access limited consent – see tech .pdf for details. It is worth browsing to see how all this is being done. It looks the same initially but really is different in some very sensible ways.
What do people think?
David.