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, August 03, 2017

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

August 3, 2017 Edition.
On the overseas front we now see President Trump firing all and sundry and appointing an apparent psychopath (known as ‘The Mooch’) as his Communications Director. The speed at which this is going downhill is just amazing!
Additionally Trump is in awful trouble with his so called ‘health care reform’ legislation. Every tactic to get even minimal change legislated has failed making it totally clear that the US is basically ungovernable.
Worse for Trump the Congress has now passed a law to make the Russian sanctions tighter and the majority is apparently veto-proof.
Of course we have also had more North Korean missile firing!!
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In Australia Labor continues to lead in the polls and the farce of who can and can’t be in Parliament because of citizenship has spun totally out of control – distracting everybody.
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Here are a few other things I have noticed.
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National Budget Issues.

Big four banks slash lending to coal miners

Clancy Yeates
Published: July 24 2017 - 12:06AM
Australia's big banks have slammed the brakes on project finance lending to expand the coal industry since late 2015, but are still lending billions for other fossil fuel developments, environmental finance group Market Forces says.
ANZ and Commonwealth Bank, previously named as the largest lenders to fossil fuels, both signalled they were actively reducing loans to some carbon-intensive sectors including the coal industry, with CBA linking this to the Paris climate change agreement in 2015.
Westpac and National Australia Bank have also toughened their stance on lending to coal mining recently, as all four banks are targeted by environmental groups.
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Big business influence wanes as public rejects 'bizonomics'

Ross Gittins
Published: July 24 2017 - 12:15AM
The collapse of the "neoliberal consensus" is as apparent in Oz as it is in Trump's America and Brexitting Britain, but our big-business people are taking a while to twig that their power to influence government policy has waned.
Their trouble is the way the era of micro-economic reform initiated by the Hawke-Keating government in the 1980s eventually degenerated into "bizonomics" – the pseudo-economic belief that what's good for big business is good for the economy.
Part of this is the belief that when you privatise a government-owned business, or outsource the delivery of government services to for-profit providers – when you move economic assets and activity from the "public" column to the "private" column – you've self-evidently raised economic efficiency and wellbeing.
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Shorten tax policy takes aim at high-income earners

  • The Australian
  • 12:00AM July 24, 2017

Rachel Baxendale

Bill Shorten has indicated he plans to wind back tax concessions for high-income earners as part of an imminent tax reform policy, ­declaring Australia has a “two-class” system.
The Opposition Leader would not be drawn on details yesterday, but said Labor was “very close” to announcing them. “I’m going to check our detail and the devil is in the detail, but watch this space,” Mr Shorten told ABC TV. “We’re going to make further tax reform announcements, but what I’m also prepared to say here is that we, as a party, are doing the hard work to create one tax system for all.”
Mr Shorten said Australia had a “two-class” tax system which needed fixing. “For most people, many will have filled in the tax ­returns and they’ll claim a couple of vanilla deductions, maybe a ­salary sacrifice motor vehicle if they’re lucky and maybe work costs,” he said.
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Is this as good as it gets for the Aussie dollar?

Jens Meyer
Published: July 24 2017 - 11:12AM
The Australian dollar is holding near two-year highs despite the Reserve Bank cooling speculation of an impending rate hike, but a jump above the US80¢ hurdle is looking more elusive.
The currency had rallied 5 per cent over the past two weeks, with gains accelerating after optimistic sounding RBA minutes, which surprised markets last Tuesday with a discussion of the appropriate "neutral" cash rate.
It shot up to a two-year high of US79.89¢ before deputy governor Guy Debelle on Friday spoiled the party by hosing down expectations of a nearing rate rise, saying the central bank did not intend to signal anything by discussing the neutral rate.
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IMF sees US fading as growth engine

Published: July 24 2017 - 2:58PM
The world is leaning less on its biggest economy to sustain the global recovery, according to the International Monetary Fund.
The fund left its forecast for global growth unchanged in the latest quarterly update to its World Economic Outlook, released in Kuala Lumpur on Monday.
The world economy will expand  by 3.5 per cent this year, up from 3.2 per cent in 2016, and by 3.6 per cent next year, the IMF said. The forecasts for this year and next are unchanged from the fund's projections in April.
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Turnbull government moves a step closer to export controls for gas producers

Adam Gartrell
Published: July 24 2017 - 12:00AM
The Turnbull government is moving a step closer to slapping export restrictions on liquefied natural gas producers as part of its bid to secure domestic supply and bring down prices.
Resources Minister Matt Canavan will give formal notice to LNG producers on Monday that he will use the Australian Domestic Gas Security Mechanism to assess whether 2018 will be a gas "shortfall year".
Introduced on July 1 as part of the Coalition's energy security push, the mechanism allows the government to intervene in the LNG market to ensure there is sufficient gas supply to meet the needs of Australian consumers. It can do so by requiring those LNG projects which are drawing gas from the domestic market to limit exports or find offsetting sources of new gas.

Taking on family trusts a brave decision, Bill Shorten

Michael Pascoe
Published: July 24 2017 - 4:54PM
In a 2011 speech, then shadow treasurer Joe Hockey said we should consider taxing trusts at the 30 per cent company rate.
The Henry tax review suggested something along those lines, but Hockey's thought bubble didn't last 24 hours – he was forced to backtrack at warp speed under pressure from his own party and the Nationals.
Fast forward six years, and Bill Shorten is hinting that family trusts will be among his targets when he unveils Labor's full tax policy on Sunday. A brave decision, Opposition Leader.
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Trading the great global repricing as central banks pull back

  • Leslie P. Norton
  • The Australian
  • 12:00AM July 25, 2017
Can central banks safely withdraw the emergency, ultra-accommodative policy introduced after the 2008 financial crisis without causing the economy and markets to collapse?
That question bedevils investors today and was an apt one for Sassan “Sass” Ghahramani, founder and CEO of SGH Macro Advisors. Ghahramani, 54, has a long history of researching markets and policy for investors and policymakers.
Born in Iran to a diplomatic family, he became a foreign exchange trader and went on to run Medley Global Advisors, with a specialty in the Group of Seven nations, emerging markets, and energy.
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  • Updated Jul 20 2017 at 11:00 PM

APRA's done well, but government undermines its own Financial System Inquiry

by David Murray
APRA's determination of the standards for unquestionably strong capital backing in Australia's banks brings to a close one of the central pillars of the 2014 Financial System Inquiry, namely the resilience of the financial system. The other pillars were superannuation and retirement income, innovation, consumer outcomes and the regulatory architecture.
In an otherwise turbulent time for the industry it brings an element of certainty for banks, their shareholders, customers and employees.
It also marks one differentiating feature of the FSI, namely, its focus on the special characteristics of the Australian economy – with its foreign capital dependency – and the need to protect the taxpayer when the occasional systemic failure strikes from within or abroad. That protection, however, was not intended to be a guarantee of the unquestionable strength of the system, but a positioning of Australian banks as unquestionably strong in their capital backing relative to their peer group around the world. To the extent that additional capital might push up costs, the FSI saw this as an insurance premium since more capital would reduce insolvency risk in a crisis.
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Tap-and-go kills the cash cow

Liam Mannix
Published: July 25 2017 - 4:15PM
Australia has become a nation of tappers, with official figures showing that the card has finally overtaken cash as our most-frequently-used payment method.
And younger Australians are increasingly choosing to make those transactions on debit cards rather than credit cards.
The share of payments made using a credit or debit card has doubled since 2007, according to a report released by the Reserve Bank of Australia on Tuesday.
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Bottom of the cliff? Investment boom is over

Mathew Dunckley
Published: July 26 2017 - 12:15AM
The completion of a series of huge gas facilities around the country is pulling back the value of major projects on the horizon, a study from Deloitte Access Economics has found.
Deloitte's quarterly investment monitor, to be released on Wednesday, showed the total value of projects tracked had fallen to $744.7 billion, its lowest level in seven years. That figure included "possible" projects through to those under construction.
The value of definite projects, which included those under construction or committed, had fallen to about $350 billion, a drop of 18 per cent on a year ago. 
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Time ripe for broader banking inquiry: ALP

July 25, 201711:45am
Colin Brinsden, AAP Economics Correspondent Australian Associated Press
Federal Labor plans to widen its promised banking royal commission to include financial regulators if it wins government, but Treasurer Scott Morrison says all it would do is encourage a "lawyers' picnic".
Shadow treasurer Chris Bowen believes the scale of industry change since David Murray's 2014 financial systems inquiry warrants another stocktake.
The opposition's promised royal commission into bank behaviour would also look into the regulation architecture, Mr Bowen told the Financial Services Council leaders' summit in Sydney on Tuesday.
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The threat of terrorism in Australia is a scam that costs us dearly

Ross Gittins
Published: July 25 2017 - 11:57PM
These days there aren't many scams bigger than all the fuss we're making about the threat of terrorism coming to our shores.
What makes the scam worse is that we bring it on ourselves.
According to a survey conducted by the Australian National University last year, 45 per cent of people said they were somewhat or very concerned that they or their family could be the victim of a terrorist attack in Australia.
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Inequality increasing, says Reserve Bank governor Philip Lowe

John Collett, Peter Martin
Published: July 26 2017 - 3:11PM
Reserve Bank of Australia governor Philip Lowe has waded into the highly charged debate over inequality in Australia contradicting Treasurer Scott Morrison's insistence that the differences between the haves and have-nots are diminishing.
Opposition Leader Bill Shorten's recently claimed that inequality has reached a 75-year high prompting Mr Morrison to accuse the opposition of pedalling a "lie".
Dr Lowe told a charity lunch in Sydney organised by Australian Business Economists that inequality "grew quite a lot in the 1980s and the 1990s and it has risen a little bit just recently".  
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RBA backtracks on suggestions of higher interest rates as inflation stalls

Elizabeth Knight
Published: July 26 2017 - 4:41PM
 For all those punters panicking about the prospects of an interest rate increase being imposed by the Reserve Bank, the latest inflation data should allow them the opportunity to chill for the time being.
The RBA has now been sidelined when it comes to moving the interest rate. It has nowhere to go. Inflation is sluggish and the Australian dollar is too high.
Not even the increased costs of some fruit and vegetables brought about by Cyclone Debbie or post January sales moves in clothing and footwear were enough to push consumer prices and the cost of living up enough to pop the consumer price index enough to offset the deflation impacts in other areas.
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CPI: Egg on faces as forecasters reassess prospects of rate hike

Peter Martin
Published: July 27 2017 - 12:15AM
There is egg on some faces after this one. Just one of the 24 forecasters surveyed by Bloomberg ahead of Wednesday's inflation result expected anything as low as 0.2 per cent.
The central forecast was 0.4 per cent, and the highest, 0.8 per cent, enough to push up the annual inflation rate to 2.5 per cent, right in the middle of the Reserve Bank's 2 to 3 per cent target band.
The highest forecast was from Stephen Koukoulas of Market Economics who says he expected a much bigger impact on fruit and vegetables from Cyclone Debbie and hadn't expected it to be offset by falls in the prices of seasonal fruits such as oranges, mandarins and apples.
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Why Scott Morrison isn't entitled to his own facts on inequality in Australia

Jul 26, 2017, 8:59 AM
 “You are entitled to your own opinion, but you are not entitled to your own facts”, the great American professor-turned-senator Daniel Patrick Moynihan used to enjoy saying to opponents.
I thought of Moynihan’s words this week when Scott Morrison claimed that inequality has “actually got better”. From a twitter troll, the claim might be laughed off. But when the Treasurer of Australia is making up the numbers, it’s nothing to chuckle about.
Since 1975, the Australian Bureau of Statistics has collected data on earnings inequality. Over this period, real wages have grown by 72% for the top tenth, but just 23% for the bottom tenth. Put another way, the top tenth of earners earned twice as much as the bottom tenth in 1975, but by 2014 they earned nearly three times as much. If low-wage earners had enjoyed the same percentage gains as the highest paid, they would be $16,000 a year better off.
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Scott Morrison's crackdown on tax deductions for property investors has been revealed

Treasury has released details for proposed cutbacks on the deductions for travel and household goods for residential investment properties as part of plans announced in the budget.
Treasurer Scott Morrison announced plans to eliminate travel expense deductions for negatively geared properties in May. While the legislation has yet to pass, it will be backdated to July 1, applying to all travel to residential investment properties, including inspections and maintenance.
The changes are also in response to concerns about the rising level of asset allocation being attributed to household goods in investment properties, which are then written off.
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RBA governor signals ignorance of the real world

Michael Pascoe
Published: July 27 2017 - 10:27AM
For some 35 years, it's been a major part of my job to observe, report and comment on the Reserve Bank of Australia (RBA). In that time, I can't remember a worse speech by a governor than that delivered by Philip Lowe at the annual Anika Foundation lunch on Wednesday.
I'm a big fan of the RBA – we've been very fortunate with the quality of culture and leadership, the integrity of thought and research, at our central bank. Which makes it so surprising that the governor either didn't consider, or chose to omit, two important reasons for our stubbornly low wages growth.
In more than 3000 words on the labour market and monetary policy, with a specific section on the mystery of low wages growth, there was not a single mention of the decline of unionism. The words "unions" or "organised" do not appear in the speech.
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  • Updated Jul 27 2017 at 11:00 PM

Coles reveals the rising pressure on households

The seminal speech by Coles managing director John Durkan in Sydney on Thursday should be a wake-up call for Australian business as it contemplates the longer-term implications of the deteriorating finances of Australian households.
Several weeks after Durkan launched a spirited attack on Coca-Cola for forcing Australians to pay more for the soft drink than anywhere else in the world, he has now turned his attention to Heinz for the price of its baked beans and Mars Inc for its M&Ms.
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Prudential watchdog warns health insurers against complacency

  • The Australian
  • 12:00AM July 28, 2017

Sarah-Jane Tasker

The prudential regulator has warned health insurers that complacency is developing in the sector, and says further work is needed in risk governance and risk management.
Peter Kohlhagen, senior manager, policy development, at the Australian Prudential Regulation Authority, said a review by the regulator of management practices among health insurers showed that although many companies considered risk management and governance, there was significant variation between insurers in terms of the maturity of processes.
Mr Kohlhagen, speaking yesterday at a health insurance summit in Sydney, said complacency could lead to less than optimal risk management and governance practices throughout the ­industry.
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Australia's gender pay gap to last another 50 years

Tom McIlroy
Published: July 27 2017 - 12:28PM
The entrenched gender pay gap is expected to remain in Australian workplaces until at least 2067, a federal government agency has told Parliament.
Workplace Gender Equality Agency boss Elizabeth Lyons was asked during Senate estimates hearings how long it would take for the gap between men and women's pay to be closed in Australia.
The answer is a stark reminder for employers, women and men in the workplace.

'It All Adds Up' podcast episode 6: Five myths about the housing market busted

Published: July 27 2017 - 3:45PM
It eats up the biggest chunk of most household budgets; housing is a hot button topic for all Australians, owners and renters alike.
In this week's episode of the Fairfax Media podcast "It All Adds Up", the team, Jessica Irvine, Matt Wade and Ross Gittins, respond to listener questions and bust these five myths about Australia's housing market.
1. Rents will skyrocket if negative gearing is abolished
When negative gearing was abolished in the 1980s, there was a steep rise in rental prices in Sydney and Melbourne. But "correlation is not causation", Irvine cautions.
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Home ownership is in sharp decline across most of Sydney

Matt Wade
Published: July 28 2017 - 11:07AM
Home ownership rates have plunged across a swathe of Sydney's inner and middle-ring suburbs.
The proportion of home owners declined in 87 per cent of Greater Sydney neighbourhoods between 2011 and 2016, analysis of census data by the Grattan Institute think-tank shows.
But the falls are most dramatic in a band of suburbs between about 10 and 25 kilometres to the west and south-west of the central business district.
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$51 billion budget bonus in Greens plan to curb negative gearing

Peter Martin
Published: July 29 2017 - 12:00AM
The Australian Greens are preparing to unveil the most ambitious plan yet to get young people into homes, costed at an extraordinary $51 billion.
The $51 billion figure is a net saving to the budget rather than a cost, calculated over 10 by the Parliamentary Budget Office.
The three-point plan, Houses for Young People: Freeing up Investment Properties, would phase out the capital gains tax discount available to property investors over five years.
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  • Updated Jul 28 2017 at 4:36 PM

Why a small rise in interest rates will hurt like the 1980s

Costs for many homebuyers have jumped by up to 150 basis points over the past 12 months and are expected to continue rising even if low inflation means an official rate hike from the Reserve Bank of Australia is unlikely in the near term.
Owner-occupier borrowers are paying between 30 and 40 basis points more and rates on interest-only and investor loans are up by 70 to 150 basis points, according to consultancy Digital Finance Analytics (DFA).
There has been a small decrease in average principal and interest, owner-occupier loans because of regulatory pressure on lenders to encourage borrowers to reduce debt.
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Ross Gittins: Last charge of the rate-rise brigade

Ross Gittins
Published: July 29 2017 - 12:15AM
Do you realise the Reserve Bank board hasn't changed Australia's official interest rate from 1.5 per cent for almost a year? But that hasn't stopped people in the financial markets from speculating furiously about whether rates are about to go down – or go up.
In the days leading to the board's meetings on the first Tuesday of the month, the market players start arguing and laying their bets.
It's clear the Reserve will have to start raising its official interest rate – also known as the short-term money market's overnight "cash rate" – to dampen the house price boom in Sydney and Melbourne, some people argue.
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Trust buster: Bill Shorten promises $17.2 billion tax crackdown

James Massola
Published: July 30 2017 - 12:09AM
Bill Shorten will slam the door shut on tax loopholes that let high income earners legally use trusts to slash their tax bills, in a move designed to raise $17.2 billion over 10 years.
The new tax policy, foreshadowed by Fairfax Media a week ago, is the second-largest revenue raising measure announced by the federal opposition, after its ambitious plan to curb capital gains and negative gearing tax breaks, designed to raise $37 billion over 10 years.
Mr Shorten will tell Labor's NSW conference on Sunday that, if he wins the next election, he will introduce an across-the-board minimum 30 per cent tax rate on discretionary trust distributions to people over the age of 18.
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Wealth divide widens between old and young generations

July 29, 201712:38am
OLDER generations are grabbing a growing slice of the nation’s record wealth as their children and grandchildren slip further behind.
An analysis of Australian Bureau of Statistics data stretching back more than 15 years shows that the average net worth of people nearing retirement has grown by seven times as much as 25-to-34 year olds.
Today’s 55-to-64 year olds are worth an average $1.24 million — an $844,000 increase since 2000, while those in their late 20s and early 30s have average net worth of $269,000, up $120,000 in the same period.
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The diminishing return of human work

  • The Australian
  • 12:00AM July 29, 2017

Alan Kohler

On Wednesday Reserve Bank governor Philip Lowe joined the ranks of the openly perplexed.
Central banking used to be simple, but not easy; now it’s both complex and hard.
If wages grew too quickly, threatening a rise in inflation, you hiked interest rates until demand fell and the pool of unemployed grew so that firms could, and would have to, say no to wage rises. When (not if — this always happened) the whole thing overshot and unemployment rose too far, you cut rates again to lift demand and get things moving. And it was all nicely mapped out by the Phillips Curve.
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The real reasons why our power prices are going up

July 29, 201711:32am
AS POWER prices skyrocket it looks like another war on renewables and climate change action is set to be fought.
And consumers are likely to be the losers once again, with everyone pointing fingers about who’s to blame for rising prices.
While former prime minister Tony Abbott once boasted that abolishing the carbon tax would provide instant relief from rising power prices, the impact was short lived with prices now higher than they have ever been in all cities except in Hobart, Darwin and Melbourne.
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Health Budget Issues.

Female GPs outnumber male GPs for the first time in Australia

Kate Aubusson
Published: July 23 2017 - 6:00AM
A photograph of a dapper group of gentlemen in double-breasted suits hangs on an office wall of the Royal Australian College of General Practitioners (RACGP).
They are the doctors who founded the college in 1958.
Nearly 60 years later, female GPs outnumber their male colleagues for the first time in Australia.
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Aveo revelations prompt government to move on retirement village industry

Cara Waters
Published: July 25 2017 - 8:55PM
State and territory consumer affairs ministers will consider allegations of unfair practices at retirement villages, Consumer Affairs Minister Michael McCormack announced on Tuesday. 
The move follows a joint Fairfax Media and Four Corners investigation that put the spotlight on the retirement village industry, particularly Aveo, one of the biggest operators.
The investigation uncovered a litany of questionable business practices at Aveo, including churning of residents, fee gouging, safety issues and misleading marketing promises, such as safety and emergency services, made to some of the country's most vulnerable people.
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'We have been waiting for this moment for so long': hepatitis C patients have access to cure with Epclusa PBS listing

Kate Aubusson
Published: July 28 2017 - 5:00AM
More than 200,000 Australians with hepatitis C will soon be able to afford a new, highly effective treatment for the chronic, highly stigmatised infection.
From August 1, the Turnbull government will subsidise the drug Epclusa, a bumper medication combining the two antivirals sofosbuvir and velpatasvir, Health Minister Greg Hunt is set to announce on Friday.
The PBS listing means patients will pay a maximum $38.80 a month ($6.30 for concession patients) for the medication that would otherwise cost over $20,000 per treatment.
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Rewards to reduce crush in hospitals

  • The Australian
  • 12:00AM July 29, 2017

Sean Parnell

GPs would be paid to prevent chronically ill patients being hospitalised and hospitals fined for readmissions that could have been avoided, under a reform proposal considered so important that Health Minister Greg Hunt is willing to offer the states a ­10-year funding deal for their ­support.
Under the extraordinary proposal, described internally as the “third wave” of reform, the commonwealth would seek to tilt the health system towards paying for better outcomes, not just funding hospital treatment without regard to whether it could have been avoided.
Mr Hunt told The Weekend Australian that in a gesture of goodwill, he was prepared to consider an unprecedented 10-year funding deal with the states, ­rather than the normal five-year agreement due to be negotiated next year.
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Bupa’s call to scrap approval process for health cover premiums

  • The Australian
  • 12:00AM July 29, 2017

Sarah-Jane Tasker

Health insurance giant Bupa has called on the government to remove the need for ministerial approval for annual premium increases to improve competition in the sector.
Bupa has made the call in its submission to a Senate inquiry on the sector, while renewing calls to continue overhauling the cost of medical devices.
The largest health insurance provider in the country has said that it paid 95 per cent more in Australia for one type of pacemaker compared to what it paid in Britain. It also said there was a 224 per cent mark up on a ceramic hip between a private and public hospital in Australia.
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International Issues.

The China-India clash that could lead to nuclear war

Peter Hartcher
Published: July 25 2017 - 12:00AM
What if they held a party for the Asian century and Asia's mega-states came dressed for a war? The century is only 16 years old and China and India are already locked in military stalemate over their disputed border in the Himalayas and talking of teaching each other a lesson.
The two ancient civilisations are also surging great powers, the only countries with populations of more than one billion people. It's the first time in half a millennium that both have been on the rise at the same time. It's also a drastically under-reported event in the wider media.
The five-week confrontation between the two nuclear states points to the uncomfortable fact that there is no agreed map of the borders between Asia's nation states, much less any agreement on who will write the agenda for any "Asian century".
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Kushner's damning account: At the very least, he's in over his head

Jennifer Rubin
Published: July 25 2017 - 4:21AM
Earlier on Monday, the Washington Post reported: "Jared Kushner, President Trump's senior adviser and son-in-law, plans to detail four meetings he had with Russian officials during the 2016 campaign and transition period - including one set up by Donald Trump jnr with a Russian lawyer - but will deny any improper contacts or collusion in testimony to a congressional panel on Monday." Of most interest, he describes the meeting with Donald Trump jnr and a Russian attorney, former Russian counterintelligence agent and Russian interpreter:
"Kushner also describes attending a June 2016 meeting organised by his brother-in-law, Donald Trump jnr, with a Russian attorney. He says it was listed on his calendar as "Meeting: Don Jr. | Jared Kushner." He writes that he arrived at the meeting late, and when he got there the Russian lawyer was talking about a ban on US adoptions of Russian children.
"'I had no idea why that topic was being raised and quickly determined that my time was not well-spent at this meeting,' Kushner writes. 'Reviewing emails recently confirmed my memory that the meeting was a waste of our time and that, in looking for a polite way to leave and get back to my work, I actually emailed an assistant from the meeting after I had been there for 10 or so minutes and wrote, "Can u pls call me on my cell? Need excuse to get out of meeting." ' "
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US senators caught on hot mic: Donald Trump is 'crazy,' 'I'm worried'

Philip Bump
Published: July 26 2017 - 4:11AM
At the end of a Senate subcommittee hearing on Tuesday morning, chairman Susan Collins, a Republican senator from Maine, didn't switch off her microphone. Apparently speaking to Senator Jack Reed from Rhode Island, the ranking Democrat of the committee, Collins discussed the federal budget - and President Donald Trump's lack of familiarity with the details of governing.
After Reed praises Collins' handling of the hearing, she laments the Trump administration's handling of spending.
"I swear, [the Office of Management and Budget] just went through and whenever there was 'grant,' they just X it out," Collins says. "With no measurement, no thinking about it, no metrics, no nothing. It's just incredibly irresponsible."
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  • Jul 27 2017 at 9:27 AM

Donald Trump, Jeff Sessions and America's looming constitutional crisis

by Edward Luce
The guns of August are cocked and ready. Donald Trump is wondering aloud whether to fire his attorney-general, Jefferson Sessions. Coming from the top, such speculation can only end in Mr Sessions' departure.
The US president is also musing about who will rid him of the troublesome special counsel, Robert Mueller. That, too, must eventually end in Mr Mueller's exit. Both are a question of timing. My hunch is August.
But it could be months away. Or tomorrow.
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White House rift boils over as Scaramucci jabs at Priebus over leaks

Margaret Talev
Published: July 28 2017 - 2:57AM
Internal White House tensions exploded into a public spectacle on Thursday as Communications Director Anthony Scaramucci undermined Chief of Staff Reince Priebus on live television by suggesting he was behind some of the leaks that have sparked turmoil in the White House and anger from President Donald Trump.
"If Reince wants to explain that he's not a leaker, let him do that," Scaramucci told CNN during a half-hour live phone interview. "I'm a straight shooter. I'll go right to the heart of the matter."
Scaramucci's remarks laid bare a power struggle among factions within the administration as it finds itself under siege by multiple investigations and stalled on its agenda. The statements will be a test of Priebus's grip on a job that in any other White House would be one of the most powerful in Washington. It also comes as Trump has been berating his attorney general, Jeff Sessions, in public statements and on Twitter.
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Nuclear threat: Australia 'deeply concerned' by reports North Korea will test missiles, says Julie Bishop

Stephanie Peatling
Published: July 27 2017 - 11:08AM
Foreign Minister Julie Bishop says the Turnbull government is aware of reports North Korea is planning to conduct missile tests on Thursday and repeated her calls for China to do more to pressure the regime in Pyongyang to abandon its nuclear ambitions.
North Korea has provoked increasing alarm in capitals across the Asia-Pacific in recent months by repeatedly testing ballistic missiles in the hope of being able to deliver nuclear warheads across oceans.
There are also reports the country could develop a missile with the range to reach the United States - and northern Australia - as early as next year.
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  • Updated Jul 28 2017 at 3:54 PM

Donald Trump sleepwalks America to chaos

Donald Trump is behaving like an erratic third-world dictator. Civil war grips the White House.
Attorney General Jeff Sessions is a marked man in the President's firing line.
America's governance system this week struck an extraordinary crossroad. In Washington, it feels like the country is sleep walking towards a crisis,
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Donald Trump sacks Reince Priebus as chief of staff

Toluse Olorunnipa and Margaret Talev
Published: July 29 2017 - 8:46AM
Washington: President Donald Trump replaced his chief of staff on Friday, announcing on Twitter that he had appointed Homeland Security Secretary John Kelly to the job.
The ouster of Reince Priebus, who said he resigned on Thursday, caps a week of heightened infighting at the White House, where Priebus had been embroiled in a public feud with Trump's new communications director, Anthony Scaramucci.
"I am pleased to inform you that I have just named General/Secretary John F. Kelly as White House Chief of Staff," Trump said on Twitter. "He is a Great American and a Great Leader. John has also done a spectacular job at Homeland Security. He has been a true star of my Administration."
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Trump blasts Senate Republicans on Twitter: 'They look like fools'

Avi Selk
Published: July 30 2017 - 2:34AM
A day after a years-long effort to repeal the Affordable Care Act collapsed on Capitol Hill, President Donald Trump castigated Republican senators for their inability to pass legislation.
"They look like fools," Trump tweeted on Saturday morning. He also renewed his demand that the Senate abolish a rule requiring 60 votes for some bills, despite the fact that the filibuster had nothing to do with the health-care bill's failure on Friday.
His tweet: "Republican Senate must get rid of 60 vote NOW! It is killing the R Party, allows 8 Dems to control country. 200 Bills sit in Senate. A JOKE!"
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I look forward to comments on all this!
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David.

I Have To Say It Is Hard Not To Wonder Just Where This Is Heading!

This appeared last week:

Amazon has a secret health tech team called 1492 working on medical records, virtual doc visits

  • Amazon has a secret skunkworks lab called 1492, dedicated to health care tech.
  • Areas of exploration include a platform for electronic medical record data, telemedicine and health apps for existing devices like the Amazon Echo.
Thursday, 27 Jul 2017 | 2:30 PM ET
Amazon has started a secret skunkworks lab dedicated to opportunities in health care, including new areas such as electronic medical records and telemedicine. Amazon has dubbed this stealth team 1492, which appears to be a reference to the year Columbus first landed in the Americas.
The stealth team, which is headquartered in Seattle, is focused on both hardware and software projects, according to two people familiar. Amazon has become increasingly interested in exploring new business in healthcare. For example, Amazon has another unit exploring selling pharmaceuticals, CNBC reported in May.
The new team is currently looking at opportunities that involve pushing and pulling data from legacy electronic medical record systems. If successful, Amazon could make that information available to consumers and their doctors. It is also hoping to build a platform for telemedicine, which in turn could make it easier for people to have virtual consultations with doctors, one of the people said.
The group is also exploring health applications for existing Amazon hardware, including Echo and Dash Wand. Hospitals and doctor's offices have already dabbled in developing skills for Amazon's voice assistant Alexa, which presents a big opportunity for the e-commerce company.
It's not clear whether Amazon is building any new health devices, but sources didn't rule it out.
When this article was originally published, on July 26, Amazon was advertising a slew of roles for its "stealth" operation, which were searchable on the jobs site under the keyword "a1.492." Some job posts described the position as "The Amazon Grand Challenge a.k.a. 'Special Projects' team." The unit also had ads posted for a UX Design Manager for its "new vertical," as well as a machine learning director with experience in healthcare IT and analytics and a knowledge of electronic medical records.
Some members of the team listed their affiliation with a1.492 on LinkedIn. Those involved include two machine learning experts; a UX designer; and two strategic initiative leads that are running projects inside the group, Kristen Helton and Cameron Charles.
As of July 27, all references to a1.492 had been removed from Amazon's jobs site and from these LinkedIn profiles. Amazon did not respond to requests for comment.
More here:
There was also further coverage here:

Wait! What? Amazon and Apple eye building EHRs

Just weeks after rumors hinted that Apple is working on a way to bring health records together on iPhones, Amazon appears to have launched an investigation about building EHR software.
July 27, 2017 04:38 PM
Amazon has started a secret lab at its Seattle headquarters to explore business prospects in the healthcare sector, including EHRs and telemedicine, according CNBC. That report comes on the heels of swirling rumors that Apple is in talks with hospitals and other healthcare organizations to explore the possibility of bringing health records together on the iPhone. 
It’s important to note that press reports thus far are based on unnamed sources and industry analysts speculate that even for the likes of Amazon and Apple stealing customers away from Epic, Cerner and Allscripts would likely be a difficult and lengthy process. 
Amazon is reportedly considering developing an EHR platform as well as telemedicine and health apps for existing devices, such as its Echo. 
Amazon has dubbed the covert team “1492,” the year Columbus first landed in the Americas, and it is hiring for positions that are searchable on Amazon using the keyword “a1.492.” The crew is also working on healthcare applications for Amazon devices, such as Echo and Dash Wand.
More here:
I wonder where all this is heading. Your guess is as good as mine!!
David.

Wednesday, August 02, 2017

I Wonder If There Is Really An Issue Here Or Is This Just A Reflection Of Some Change Resistant Senior Docs?

This appeared last week:

Doctors claim medical records system puts patient safety at risk

Kara Vickery, Janelle Miles, The Courier-Mail
July 26, 2017 12:00am
PROBLEMS with Queensland Health’s electronic medical record system are angering health workers, with fed-up senior doctors circulating a document slamming the technology and those in charge of it.
The document claims the integrated Electronic Medical Record (iEMR) puts patient safety at risk, is difficult to navigate and “unintuitive”.
The document, obtained by The Courier-Mail, likens the program to two of Queensland’s biggest health disasters, and claims the integrated Electronic Medical Record (iEMR) puts patient safety at risk, is difficult to navigate and “unintuitive”.
Referencing the infamous payroll debacle and the “Tahitian Prince” affair, the document warns colleagues the Cerner software is “coming to a hospital and health service near you”.
“Project leadership have difficulty accepting issues,” the document says.
Chief executive of eHealth Queensland Richard Ashby said he was aware of concerns among some medical specialists regarding the system.
“We are evaluating these concerns which are not shared statewide,” he said. “Extensive consultation is conducted with hospital staff prior to the rollout of iEMR, and we continuously work with our clinicians to ensure the system meets their needs and maximises improvements.”
More here:
Having recently have had three (involuntary) experiences with a Cerner equipped hospital I can report that properly provisioned and implemented the Cerner software works pretty well and is fairly straightforward to use even by rather doddery old patient – let alone the bright intelligent young doctors.
I just have the sense we have heard all this before from older stuck in their ways docs, but it is important to say there are always ways the software and the way it is implemented can be improved.
What do you reckon?
David.

This Fiasco Is Really Pretty Awful News Both For The US Health System And The US In General.

This appeared last week:

Republicans consider next steps after health reform setback

Published July 28 2017, 3:44pm EDT
Republicans in Congress have been unable agree on a way to repeal and replace Obamacare -- and now they’re divided on whether they should give up on their GOP-only approach.
Senator John McCain urged fellow senators Friday to "start fresh" and seek a bipartisan plan, hours after he provided the decisive vote against his chamber’s latest Obamacare-repeal proposal. "We can do this," the Arizona Republican said in a statement.
Other Republicans insist they got too close to a GOP-only agreement on demolishing Obamacare to turn back from that idea. The Senate fell one vote short of advancing a partial repeal of Obamacare early Friday, with opposition from McCain and two other Republicans. In May, the House passed its replacement plan on a razor-thin 217-213 vote.
House Freedom Caucus Chairman Mark Meadows said he has no intention of working with Democrats. "In the end, we will prevail," the North Carolina Republican told reporters Friday. "I fully expect we’ll have something on the president’s desk in September."
Senate Republican hardliner Ted Cruz of Texas also dismissed the idea of bipartisanship out of hand.
President Donald Trump’s impulse has been do nothing, let Obamacare implode and wait for Democrats to come to him to seek new legislation. There have been repeated hints that the president could stop making the healthcare law’s cost-sharing payments for low-income people, which insurers and analysts have warned would cause a spike in premiums and perhaps even a pullout from more markets.
But that’s a risky strategy, with Republicans in charge of all of Washington and the president already facing historically low poll ratings heading into a midterm election year.
White House budget director Mick Mulvaney expressed disappointment in an interview with Bloomberg TV. "We had hoped to clear the decks of healthcare last night so we could move our full attention to tax reform," Mulvaney said. With the Senate scheduled to remain in session for two more weeks before taking an August recess, he added: "All I know is we still expect them to do something before they leave town."
Earlier this week McCain made a dramatic return to the Senate following brain-cancer treatment to cast the 50th vote to start debate on the bill. But he gave the decisive thumbs-down during Friday’s vote on a bare-bones Obamacare replacement designed to jump-start bicameral talks on a final bill. The final tally was 49-51, with Republicans Susan Collins of Maine and Lisa Murkowski of Alaska also voting no.
The collapse was a blow to Majority Leader Mitch McConnell of Kentucky, who has previously said if Republicans failed they would need to cut a deal with Democrats to stabilize the markets. After the dramatic failure of his bill, the flush-faced leader declared he wasn’t interested in a "bailout" of insurance companies but wanted to hear what other ideas Democrats have.
In the Senate, half a dozen Republican and Democratic senators have discussed alternatives to the embattled GOP healthcare bill. They mostly center on creating a reinsurance fund and authorizing cost-sharing payments for insurers on the Obamacare insurance exchanges so they don’t have to raise prices for covering a sicker pool of customers. Another Democratic idea would take a bite out of drug company payments and plow the savings into the system.
Senate Minority Leader Chuck Schumer of New York told reporters Friday he’s optimistic that members of both parties can work together to stabilize insurance markets and then "sit down and trade ideas" for the long run. "Change it, improve it, but don’t just take a knife and try to destroy it and put nothing in its place," Schumer said.
Senator Lindsey Graham, a South Carolina Republican, met with Trump Friday to talk about his Obamacare replacement proposal with GOP Senator Bill Cassidy of Louisiana, according to a Republican aide. The plan, which was never embraced by McConnell or Democrats, would redirect much of the federal funding for health insurance as block grants to states to use for healthcare spending.
More here:
The outcome seems from this distance to be totally predictable as everything they wanted to do was going to take Health Insurance from tens of millions of Americans – most of whom were Trump Supporters. Amazingly there were many Senators concerned the legislation was not harsh enough – so rabid were they in their hate of anything President Obama has done.
The implications for health care in the US are unknown but they can’t be good. Trump is really turning out to be a disaster. I wonder when anyone will notice?
Back to more local matters!
David.

Tuesday, August 01, 2017

An Important Contribution To The Discussion Around The Legitimacy Of And Ethics Around The myHR.

I came upon this paper this week:

Health Privacy and Confidentiality

Health Privacy and Confidentiality, Chapter 23, in Tensions and Traumas in Health Law, I Freckelton and & K Petersen (Eds) (2017) Sydney: Federation Press, Forthcoming
17 Pages Posted: 14 Apr 2017  

Danuta Mendelson

Deakin University, Geelong, Australia - Deakin Law School

Gabrielle Wolf

Deakin Law School
Date Written: February 15, 2017

Abstract

The notion that a patient has the right to maintain the confidentiality of information disclosed in the course of a therapeutic relationship with a health practitioner has been entrenched in Western civilisation for thousands of years. For the first time, however, we have begun to witness an erosion of this entitlement, especially in Australia in recent years. The Australian Federal Parliament has created a system of co-linked national electronic health records that, by virtue of new technology, permits government bodies and myriad other third parties to access and disseminate individuals’ health information both lawfully and without authority, almost invariably in the absence of patients’ knowledge and consent. Commonwealth legislation has also facilitated the substitution of patients’ traditional right to confidentiality of their health information with a much broader and less clearly defined right to “personal privacy”. This chapter examines how these changes have led to a fundamental upheaval of longstanding understandings about the protection of information communicated and learned in the once secluded space of the consulting room.
Keywords: patients, confidentiality, electronic health records, Big Data, assymetry of power,
JEL Classification: C55, C 89, I18, I19, K19, K39
Suggested Citation:
Mendelson, Danuta and Wolf, Gabrielle, Health Privacy and Confidentiality (February 15, 2017). Health Privacy and Confidentiality, Chapter 23, in Tensions and Traumas in Health Law, I Freckelton and & K Petersen (Eds) (2017) Sydney: Federation Press, Forthcoming.
The detailed and scholarly article provides a summary of the nature of patient confidentiality / privacy through time (back to the Greeks) and then provides many pages of discussion around the myHR.
The concluding remarks are as follows:

Conclusion

“Technological advances have made possible the development of a system of national electronic health records. While the digitization of health information does not inherently undermine the confidentiality of patients’ health information, the My Health Record system that the Commonwealth Parliament has legislated to create, and the technology used to operate it, has enormous potential to do so. The old adage, “knowledge is power”, can be
interpreted in several ways, including as a shorthand for saying that, the more the State knows about its citizens, the greater the power that it can exert over them for good and for bad. The My Health Record system exponentially expands the knowledge that Australian governments, but also other third parties, can acquire about individuals’ health information and, consequently, their authority over them. The creation of the My Health Record system has coincided with the substitution of the concept of patients’ right to the confidentiality of their health information with a much broader and less defined right to personal privacy. Both developments have significantly eroded our former capacity to secure information disclosed in the course of therapeutic relationships with our health practitioners.”
I find this all rather chilling to say the least. It is not an accident that Tim Kelsey is keen on working in Australia because of our laws which seem to have eroded many of our previous assumptions regarding the our control of our personal information – and not for the better I must say. The AusHealthIT poll of July 23 shows many agree with the position expressed in this paper in terms of the privacy risks etc.
David.