Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, May 31, 2018

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

May 31, 2018 Edition.
Well things are really getting amazingly fluid regarding the NK Summit – on, off, on etc. I guess we will know on the 11th whether the 12th is on? Elsewhere is seems the Irish have had a sensible rush of blood to the head but left the six northern counties stuck in the 1950’s.
In OZ  the elections of the 28th July and the relationship of us with China seem to be the issues gaining  most attention. I hope the pollies are up to working out a reasonable modus vivendi with China – for all our sakes….
The FS Royal Commission was also awful this week with studies of human distress abounding and bankers being pilloried. I am not sure this (The RC) is not going to cause problems with credit and lending down the track as an unintended consequence.
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Here are a few other things I have noticed.
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Major Issues.

  • Updated May 20 2018 at 11:00 PM

Turnbull government's frigate call about more than capability

by Peter Jones
We can soon expect the Turnbull government to decide on which contender will become the SEA 5000 Future Frigate. When in service the nine frigates will be the backbone of the Royal Australian Navy's (navy) surface fleet for the next 30 years.
The government has shortlisted three contenders: 1) a variant of the new BAE British Type 26 frigate; 2) a version of the Fincantieri Italian FREMM; and 3) the Navantia Spanish evolved F-100 design. Last year the navy commissioned HMAS Hobart, the first of three destroyers that are a version of the F-100.
The SEA 5000 selection cannot be made in isolation from earlier government decisions. Take the SEA 1000 submarine project. It is Defence's largest project but is the highest-risk. This combination is not ideal in a portfolio of projects, as any problems could have a big knock-on effect. To mitigate risk in the portfolio, SEA 5000 should therefore be of lower technical risk.
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AGL rejects Alinta offer for Liddell power station

By Cole Latimer & Nicole Hasham
21 May 2018 — 8:51am
AGL has knocked back Alinta’s $250 million offer to buy the Liddell coal-fired power station, committing to its plan to shut down the power station in 2022.
Alinta said it was "disappointed" by the decision, which former Nationals leader Barnaby Joyce described as "BS". Former prime minister Tony Abbott called for the government to compulsorily acquire Liddell and sell it to Alinta.
In a statement to the sharemarket on Monday morning, AGL said the offer was not in the best interests of either the company or its shareholders.
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Alinta's offer to buy Liddell was never serious and everyone knew it

By Peter Hannam
21 May 2018 — 11:58am
When AGL's chairman, Graeme Hunt, phoned Josh Frydenberg to tell him the energy company would be announcing it had rejected Alinta Energy's bid for the Liddell power station, the Environment and Energy Minister is understood to have "just listened".
Realistically, what could Frydenberg say? He had already called AGL's directors personally to urge them to accept a bid that was never more than a notional one.
The $250 million cash bid for the almost half-century old Hunter Valley coal-fired power station was roughly equivalent to AGL's earnings after tax from the plant each year, so why would it sell at that derisory price?
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Life insurers’ rehab move slammed as backdoor expansion

  • The Australian
  • 12:00AM May 21, 2018

Michael Roddan

Plans to allow life insurers to cover medical costs for prevention and rehabilitation have been criticised by doctors, lawyers and health insurers as a backdoor expansion by the sector into health insurance at a time when its future is uncertain following a string of scandals.
The $60 billion life insurance industry is pushing the Turnbull government to overhaul current laws that ban insurers from paying for treatment that could help claimants return to work. The Financial Services Council, which represents the life insurance and wealth management industry, argues 12,000 workers a year could return to their jobs sooner if the laws were changed to allow life insurers to pay for early intervention treatments and medical expenses.
The industry has become increasingly interested in rehabilitation in recent years and many companies are now investing in in-house rehab resources.
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  • Updated May 21 2018 at 11:00 PM

World debt bomb is ticking, new IMF debt database shows

Is the world sitting on a debt time bomb?
A new global debt database launched by the International Monetary Fund here in Washington last week shows combined public and private debt has ballooned to at least $US164 trillion ($218 trillion).
Adding in a broader range of debt instruments, including financial sector debt, world debt is at a record high of $US243 trillion, or about 320 per cent of GDP.
Disturbingly, that excludes trillions of dollars of unfunded pensions that governments owe.
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Playing sheepish no longer cuts it in live export debate

By Mark Kenny
22 May 2018 — 12:00am
Like the public pressure that forced marriage equality on a recalcitrant Parliament, Australia’s governing MPs are trying to avoid another moral question in coming weeks: whether defenceless livestock animals have rights.
Until recently, industrial scale cruelty in the live sheep trade has been out-of-sight, out-of-mind.
But horrendous video footage has punctured that ignorance, sharpening public distaste for a trade that was at best tolerated and is now rightly viewed as unconscionable.
Through the determination of two Coalition women, Sussan Ley and Sarah Henderson, the Australian Parliament may soon get the opportunity to act, to phase-out this benighted trade. Or it may not.
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'Show me the incentive and I will show you the outcome'

By Scott Phillips
19 May 2018 — 8:00am
The banking royal commission has a devil of a job to do. To be fair, it’s doing it very well, for now, but the hardest part is yet to come.
When Commissioner Kenneth Hayne writes and releases his report, the expectation is that he’ll hand down recommendations as to how the financial services industry should be changed. And more power to him – the industry is broken and needs swift and decisive surgery.
And yet …
Just what, exactly, can the royal commission recommend that is suitably strict, yet appropriately flexible?
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Defining moment for National Disability ­Insurance Scheme

  • The Australian
  • 12:00AM May 22, 2018

Rick Morton

Rob De Luca isn’t ready to speak with you yet.
The young, newly installed chief executive in charge of the $22 billion National Disability ­Insurance Scheme was adamant he didn’t want a public email when he took over the reins in August last year.
He uses a made-up first name, keeping the address off the books because he doesn’t want ­direct emails from “normal mums and dads, agency staff and participants”, according to one disgruntled staff member.
The former Bankwest managing director has poached four other senior executives who worked for him during his five years at the helm of the Perth-based bank and has appointed them to some of the most high-ranking positions at the National Disability Insurance Agency.
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Hanson the opportunist re-emerges, fighting for her party's life

By Tony Wright
22 May 2018 — 3:39pm
If anyone in the Turnbull government really believed they’d locked Pauline Hanson into supporting tax cuts for big companies, they could only have been politically naive, lacking understanding of the concept of populism or ignorant of Hanson’s history of leading the powerful up the garden path.
The idea that Hanson would be able or, in the end, willing to sell to her One Nation followers a multi-billion-dollar tax cut to the banks and huge multinational companies without an ever-escalating list of near impossible trade-offs, ending in a letdown, was always fanciful.
And suddenly, Hanson has a purely political reason to stare down the Coalition.
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Malcolm Turnbull has just been given the perfect excuse to shelve his company tax cuts

By David Crowe
22 May 2018 — 11:16am
Malcolm Turnbull and his government have good reason to shelve their company tax cuts after seeing their signature economic policy ripped to pieces in the Senate once again.
The company tax bill was already blocked in the Senate before Pauline Hanson changed her view on the reform, but her decision puts the government policy even further out of reach.
Hanson and her One Nation colleagues have confirmed their status as the most volatile force in Parliament, shifting position with the wind but always ready with a complaint.
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  • May 23 2018 at 6:05 PM

Philip Lowe on why the RBA is watching China's debt mountain so carefully

Reserve Bank of Australia governor Philip Lowe has appealed for calm over Australia's increasingly troubled political relationship with China, while warning that its ballooning debt mountain and opaque financial system poses a threat to prosperity here.
Seeking to take heat out of the debate over China's role in Australia, Dr Lowe has none-the-less detailed his concerns over its banking system, which he says is the most likely source of an economic shock for both Australia and China.
"Not surprisingly, this risk has become a priority of the Chinese authorities - we all have a strong interest in their efforts being successful," Dr Lowe said in a speech Wednesday night.
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Maiden speeches a fleeting glimpse of ideals quickly abandoned

By Andy Marks
23 May 2018 — 3:10pm
Ged Kearney’s vow this week to humanise Australia’s policies towards refugees not unexpectedly drew the ire of Peter Dutton. The humane approach, he rehearsed, is that which prevents deaths at sea.
Maiden speeches — like Kearney’s — reveal a lot about a politician. Before the rot sets in. Before they’re dragged into the mutually assured destruction that passes for Australian parliamentary democracy.
A newly elected member or senator’s first formal statement is a spark, a fleeting glimpse of personality, conviction and belief. It’s a flicker of the traits about to be smothered by talking points, factionalism and populism.
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All aboard: private sector rushes to join latest government gravy train

By John Hewson
23 May 2018 — 1:33pm
Two key weaknesses that helped spark the pink batts and school hall policy debacles are about to strike again. This time, the National Disability Insurance Scheme and home care packages for the elderly or those with a disability are in the firing line.
A government will say the pink batt and school hall programs were an essential part of an emergency response to the global financial crisis. The aim was to get as much government money out the door, as fast as possible, to stimulate private sector activity, to avoid a recession. This was a most unusual and challenging time. We have learned from these debacles. They will not be repeated.
The pink batts home insulation scheme was plagued by problems.
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'Something scary': Nobel Prize-winning economist sees trouble ahead

By Ben Bartenstein
24 May 2018 — 7:05am
Paul Krugman is joining a growing contingent of economists and money managers from Carmen Reinhart to Mark Mobius in warning of a meltdown in emerging markets.
The Nobel Prize-winning economist said the current episode bears some resemblance to the Asian financial crisis in the late 1990s, when developing-nation stocks slid 59 per cent and governments raised interest rates to exceptionally high levels.
"It's become at least possible to envision a classic 1997-8 style self-reinforcing crisis: emerging market currency falls, causing corporate debt to blow up, causing stress on the economy, causing further fall in the currency," Krugman wrote on Twitter.
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MP Andrew Hastie's revelation in national interest

23 May 2018 — 9:01pm
Was the chair of Federal Parliament’s joint intelligence and security committee right to use the legal shield of parliamentary privilege to name one of Australia’s biggest political donors (to both major parties) as financing bribery of a United Nations executive and as having a close association with the Chinese Communist Party’s lobbying operation?
It is unlikely West Australian Liberal Andrew Hastie deployed such a power frivolously. Parliamentary privilege, enshrined in 1689 in the British Bill of Rights and willingly constitutionally inherited by Australia, gifts immunity to lawmakers from defamation and other laws, and permits them to compel, under oath, witnesses and to demand data and documents.
Providing a potent deterrent against corruption by the wealthy, vested interests or the powerful, it helps ensure parliamentarians’ freedom to debate, denounce and legislate in the public interest without fear or favour.
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If this is shipshape, then we’re sunk already

  • The Australian
  • 12:00AM May 24, 2018

David Uren

The naval ship and submarine-building program is the biggest ­industrial venture undertaken by an Australian government and ­already there are troubling signs, with Defence admitting to a ­potential $6.9 billion blowout in the submarine program before the detailed design of the vessels has begun. Planners are still trying to refine the general concept.
The admission, contained in the body of the Australian Nat­ional Audit Office’s report last week, is buried in jargon — ­Defence advised the ANAO that it “was aware there may be a need to adjust the funding profile” etc. It contained no explanation and it is not clear whether the cost of the submarine program is now $57bn rather than the originally stated $50bn or whether it is bringing forward spending ahead of 2032, when the first submarine is due for completion. Nor is there any indication of what pocket the funds might be plucked from.
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The cost of defence: ASPI Defence budget brief 2018–2019

24 May 2018
Australia’s strategic situation is deteriorating. The 2016 Defence White Paper set out six drivers that shape our security environment. None has improved since the White Paper appeared, and most have worsened significantly.
The existing rules-based global order is under threat. China simply ignores it when it chooses, for example with its de facto annexation and subsequent militarisation of the South China Sea, and is embarking on creating a new regional order that it seeks to define alone. The current leadership of the US appears unable to decide whether it wants to support the existing order, ignore it, or tear it down. Meanwhile, the relative power gap between the two continues to decrease, as China’s economy and military grows.
The development of emergent technologies such as cyber, space-based capabilities, artificial intelligence and hypersonics continues apace. We’re also seeing clear Islamic State links into terrorist attacks in Southeast Asia, some involving returned fighters. All of these developments, taken together, suggest that the ADF will be confronted with an increasingly broad spectrum of threats. The question is whether Defence can be stretched even further to cover them all, or whether it should focus on addressing particular ones.
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Old-age super products a ‘fraud’

  • The Australian
  • 12:00AM May 22, 2018

Michael Roddan

New superannuation income products backed by government reforms in the budget, which are designed to encourage older Australians to spend big in retirement, have been slammed as “actuarial fraud” by one of the country’s largest funds, the $55 billion Sunsuper.
The sentiment — which is shared by large sections of the not-for-profit super industry — marks an early setback for proposals set to be enshrined in law by Financial Services Minister Kelly O’Dwyer, who only last Thursday released a position paper on the so-called comprehensive income products for retirement (CIPRs).
This budget progressed government’s plans to encourage development of post-retirement products, with proposals to require super funds to offer specialised post-retirement products that provide income for life.
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ASIO chief Duncan Lewis sounds fresh alarm over foreign interference threat

By Bevan Shields
24 May 2018 — 11:12pm
Australia's top spy says a Liberal MP's bombshell decision to accuse a billionaire businessman of involvement in a bribery scandal has not damaged international intelligence partnerships, while also sounding a fresh alarm over the unprecedented threat of foreign interference.
In a Senate estimates appearance held amid growing diplomatic tensions between Australia and China, Australian Security Intelligence Organisation director general Duncan Lewis warned countries were trying to access classified information about Australia’s global alliances, as well as its military, economic, and energy system.
While Mr Lewis was careful to not name any particular nation, he repeated an earlier assessment that foreign interference activity against Australia was occurring "at unprecedented scale".
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Australia's $35b plan to hunt submarines

By David Wroe
25 May 2018 — 11:45pm
Off a cold and windswept island in the outer Hebrides of Scotland, a pair of Australian submarine-hunting helicopters flew recently over rough seas in Europe’s biggest naval exercise.
The waters are true submarine territory - the kind of place where the Russians played cat and mouse for decades with NATO navies.
The pair of MH-60 “Romeo” choppers helped hunt Dutch, Norwegian and British submarines that were simulating gathering intelligence from ports or blocking maritime choke points to impede sea trade.
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House prices to fall at least 5pc in 2019: UBS

  • The Australian
  • 1:42PM May 25, 2018

Samantha Bailey

Tighter credit is likely to prompt a 5 per cent drop in house prices over the next year, according to UBS economist George Tharenou.
He said that macro-prudential tightening “phase 3” is a “game changer” and that coupled with a record housing supply and a slump in foreign buyers, house prices are likely to fall more than the less-than 3 per cent the investment bank had previously forecast.
It comes after the Australian Prudential Regulation Authority announced plans to encourage the collection of borrowers’ actual expenses and instruct lenders to develop risk appetite limits on high debt-to-income loans in April, which UBS dubbed the third phase in its macro-prudential changes.
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Trade ties with EU gains strategic importance

  • The Australian
  • 12:00AM May 26, 2018

Adam Creighton

It’s hard to believe driving conditions in Sydney and Melbourne are so different from Madrid and Berlin that they warrant entirely different safety regulations. Negotiations for a free trade and investment agreement with the European Union, which began formally in Brussels this week, aren’t just about sending more cheese to France.
Jason Collins, president of the European Australian Business Council, says the EU-Australia agreement “could be our biggest FTA yet, certainly in terms of coverage and the size of the economic relationship”.
It’s easy to overlook Europe’s economic clout. The obsession with China, especially here in Australia, and the political theatre offered daily by the US are distractions from relatively dour Europe, too often seen as sclerotic.
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https://www.smh.com.au/business/the-economy/bracket-creep-lives-to-fight-another-day-20180525-p4zhgm.html

Bracket creep lives to fight another day

By ROSS GITTINS
25 May 2018 — 7:36pm
An Australian newspaper’s headline on the morning after the budget was SCOMO STOPS THE CREEP. The nation’s most ponderous political commentator intoned that the Treasurer would “eliminate bracket creep for the middle class”.
The man himself claimed his tax-cut plan “ran a sword through bracket creep”.
Sorry, yet another of Scott Morrison’s attempts to mislead us in a most misleading budget. He’s exploiting the public’s hazy understanding of what bracket creep is and how it works.
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Financial Services Royal Commission.

Welcome to the wild, wild west of lending

By Jessica Irvine
21 May 2018 — 12:05am
If you thought the banking royal commission’s most sensational hearings – of fraud, bribery and lies – were behind us; think again.
You ain’t seen nothing yet.
From Monday, the spotlight turns on the bank’s behaviour when dealing with their small business clients.
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'Our people are hurting' - NAB's Ken Henry flags pay overhaul

By Jessica Irvine
22 May 2018 — 2:42pm
The chairman of NAB, Ken Henry, has slammed Australia’s business leaders for an “unusual level of corporate complacency” as their companies had let down the public in their treatment of customers.
As the public hearings of the of Royal Commission into misconduct in the finance industry continue, the former Treasury Secretary described the process as “necessary and important”.
“The leaders of large Australian businesses have never been under greater scruitiny. All of us have a fair idea of the reasons for that. In short, we have, in several respects, fallen short of community expectations," he said.
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There is one sure way to avoid being stung as a loan guarantor

By Noel Whittaker
Updated23 May 2018 — 6:35pmfirst published at 3:50pm
Recent events at the Banking Royal Commission have highlighted the problems that can arise if you “go guarantor” for another person.
That means signing a guarantee, which is a promise to a creditor or lending institution to pay another borrower's debt if they are unable to pay it. It may be the debt of another person, or the debt of a company that you are associated with.
Why does a lender ask for a personal guarantee from another person? Because it believes there is some doubt – be it insufficient assets, insufficient income or a bad credit rating – that the original borrower will be able to repay the loan.
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  • Updated May 24 2018 at 8:00 PM

'Very unsafe': Lawyers concerned about Hayne 'inquisition'

Lawyers are voicing concerns about the lack of procedural fairness for banks and individuals appearing before the Hayne royal commission, saying the allegations raised can do irreparable harm to their reputation even if they are ultimately not proved.
This was particularly so for submissions about breaches of criminal provisions, lawyers said, because in an ordinary criminal court case the accused would be given a proper opportunity to defend themselves.
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Bank of Melbourne used customer's $100k as 'bargaining chip'

By Clancy Yeates
25 May 2018 — 1:13pm
The Bank of Melbourne tried to deal with a mistake by one of its bankers by locking up $100,000 of a customer's money in a term deposit that could not be withdrawn, the royal commission has heard.
The bank's decision, made without any consideration of whether it was legally entitled to do so, was an "abuse of the bank's power", senior counsel assisting Rowena Orr said on Friday.
The banking royal commission hears how the Bank of Melbourne locked away $100,000 of a customer's money as it tried to fix its own mistake with a loan, effectively using it as a "bargaining chip".
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  • Updated May 25 2018 at 4:15 PM

When loans from Bank of Mum and Dad can go wrong

Woman faced losing home after guaranteeing loan
Lawyers are warning about a big increase in children "bullying" their parents into signing mortgage contracts or, in the case of ageing parents, simply helping themselves to their cash and investment accounts.
Soaring property values, lender demand for bigger deposits and tougher terms are contributing to a 25 per cent increase in contributions by the so-called Bank of Mum and Dad (parents lending to their children for home purchases) to about $20 billion in the past 12 months.
But parental funds are fueling explosive family disputes and complex legal wrangles as parents fight children, children sue parents and siblings battle it out in expensive, protracted legal disputes.
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National Budget Issues.

5:48am, May 21, 2018

Crossbench senators name digital price for passing budget tax plan

Crossbench senators would support the government’s $175 billion tax plan in exchange for a tax on digital companies such as Google, Facebook and Uber.
The government needs two more votes to get its plan to cut income tax for lower- and middle-income earners and lower the corporate tax rate passed in parliament.
Centre Alliance senators Stirling Griff and Rex Patrick were “100 per cent behind a digital economy tax proposal”, Fairfax Media reported Monday.
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New levy on digital giants sways crossbench on tax cuts

By Eryk Bagshaw
21 May 2018 — 12:01am
A new tax on digital giants including Google, Facebook and Uber has won support from crucial Senate crossbenchers, clearing the way for a possible vote within weeks on two Turnbull government flagship economic policies worth $175 billion.
As Parliament resumes for a new round of negotiations over the government's $140 billion income tax cut plan and its stalled $35.6 billion bid to lower the corporate tax rate for big businesses, influential independent senators have told Fairfax Media a digital tax would help sway their votes.
And treasurer Scott Morrison has confirmed a tax targeting some of the world's largest and most popular companies is now inevitable, with Labor providing in-principle support for a crackdown on digital companies.
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  • Updated May 21 2018 at 7:21 PM

Key senators back EU-style 3 per cent tax on digital giants

Key crossbench Senator Stirling Griff says his party would support a 3 per cent tax on digital giants, like that being proposed for the European Union, as the government continues to seek backing for its company tax cuts.
The government is just two Senate votes short of securing the passage of its legislation for the remainder of the tax cut package and is hoping clampdowns on multinationals can convince Senator Griff and his Centre Alliance colleague Rex Patrick to come on board.
Senator Griff said on Monday that if they could be convinced there was sufficient revenue over the medium term to fund both the company tax cuts, worth $35 billion over 10 years, and the income tax cuts, worth $140 billion over 10 years, as announced in the budget, without having to cut essential services, such as health and education, then they could vote for both packages.
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Cry for the banks. They'll pay more in the levy than they'll make in tax cuts

By Peter Martin
21 May 2018 — 7:43pm
Australia’s big four banks and their shareholders will recover very little of the new major bank levy from the proposed cut in company tax, a Fairfax Media analysis has found.
In fact, the proposed company tax cut and the major bank levy would leave banks more highly taxed than they were before the 2017 budget.
The levy, which came into force in the middle of last year, is expected to raise $1.6 billion a year from each of the big four banks and Macquarie Bank.
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Nervous Coalition MPs privately consider the pros and cons of shelving their company tax cut policy

By David Crowe & Eryk Bagshaw
22 May 2018 — 11:45pm
Prime Minister Malcolm Turnbull is facing a new test over his contentious plan to cut company taxes after a spectacular backflip by Pauline Hanson left the reform stranded in the Senate and prompted Coalition backbenchers to warn the saga could cost them the next election.
The damaging blow has fuelled fears across a nervous Coalition backbench about the political danger of sticking with the stalled policy, despite the Prime Minister’s pledge to stand by it.
The shock is also hardening resolve within the government to seek a Senate vote on its full $140 billion bid to cut personal income taxes, rejecting the idea of splitting the bill into stages given the turbulent experience of navigating multiple phases of the company tax reduction.
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Parties offer clear choice at next election

By ROSS GITTINS
23 May 2018 — 12:05am
The federal election campaign could be as soon as August and no later than May. So which side is shaping as better at managing the economy?
Sorry, I won’t be answering that question. If you’re smart enough to choose to read this august organ, you’re smart enough to make up your own mind – which you probably already have.
The partisan or tribal approach to politics – if my side’s proposing it, it’s what I prefer – is a common way of economising on thinking time.
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'Obviously' ... Turnbull can use old one-liner to back down on company taxes

By Peter Martin
23 May 2018 — 11:54am
How do you walk away from something to which you’ve committed your soul? You say things have changed, “obviously”.
It’s how marriages end in divorce, how deputies abandon their prime ministers and how Labor treasurer Wayne Swan quietly but spectacularly abandoned his absolute commitment to a budget surplus in late 2012.
He had been holding the line for half a decade, promising in his first budget “the largest surplus as a share of GDP in nearly a decade”, and then in his second, after the surplus evaporated during the financial crisis, “hard choices that chart the course back to surplus”.
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Scott Morrison reveals new details on income tax cuts as Labor votes for full package

By David Crowe
23 May 2018 — 8:08pm
Treasurer Scott Morrison has revealed the full cost of the final phase of his sweeping personal tax cuts in a vigorous debate in Parliament that shone new light on the most expensive element of the budget plan.
The new details emerged during an important vote where Labor chose to back the entire seven-year package to avoid being accused of blocking benefits for ordinary workers.
Mr Morrison told Parliament the cost of the policy over 10 years would be $143.95 billion, a slight increase on the estimate of $140 billion aired when the budget was released on May 8.
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10:00pm, May 23, 2018 Updated: 11:20pm, May 23

Morrison finally reveals billion-dollar price tag to ‘flatten’ tax system

The Turnbull government’s contentious “flattening” of the nation’s tax system will cost more than $40 billion, Scott Morrison has confirmed, as the Treasurer’s personal income tax package passed the lower house.
The cost had remained a mystery until Mr Morrison provided more details during a feisty debate in Parliament on Wednesday night.
The proposal to scrap the 37 per cent tax bracket, meaning people earning between $41,000 and $200,000 would pay a top rate of 32.5 per cent, comprised $42 billion of the total $143.95 billion cost over a decade.
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Crossbench push to lock Australia's 560 largest companies out of tax cuts

By Eryk Bagshaw
24 May 2018 — 12:05am
Woolworths, Caltex, Imperial Tobacco and the Ten Network would be among the hundreds of companies frozen out of the $35.6 billion remaining of the company tax package under a renewed push to cut benefits to companies with a turnover of more than $500 million a year.
The move, mooted by Senate crossbenchers to get the terminal tax cuts across the line, would see an extraordinary $1.5 trillion in turnover per year quarantined alongside more than 560 companies, according to figures from the Australian Tax Office.
While the data does not show company profits – the pool of money from which taxes are paid – it indicates the slab of the economy that could be excluded to bring crossbenchers back to the negotiating table.
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Budget hangover we had to have

  • The Australian
  • 12:00AM May 25, 2018

Adam Creighton

The topic I was given was simply: Budget 2018, The Aftermath.
I asked myself what is the aftermath for a budget? For journalists, the aftermath is typically a bad hangover. And that’s not an entirely dissimilar experience for the nation as a whole.
Extra spending must ulti­mately be paid for, through taxes, so to the extent taxes damage the economy we all in a sense suffer a hangover on budget morning.
Budgets have become political more than economic documents and as such they entail announcement of new spending.
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Health Budget Issues.

Mental health system 'overwhelmed and underfunded'

By Lucy Stone
22 May 2018 — 9:47pm
Queensland’s regional and rural mental health patients, in particular, are still struggling to access specialist help under an ongoing national shortage of practising psychiatrists.
Royal Australian and New Zealand College of Psychiatrists president Dr Kym Jenkins said there were roughly two psychiatrists per 100,000 people in regional and rural Queensland.
In contrast, city centres are likely to see a ratio of about 18 psychiatrists per 100,000 people.
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Two private hospitals to shut after operator says they're 'not viable'

By Simone Fox Koob
22 May 2018 — 12:03pm
Two private hospitals in Geelong and Kew are to be shut down within a month, putting more than 400 jobs at risk, after operator Healthscope announced it was no longer viable to keep them running.
Geelong Private Hospital – formerly known as Baxter House – and Cotham Private Hospital in Kew will be both be closed gradually over the next four weeks, leading to the loss of 417 jobs across the two institutions.
Employees were made aware of the closures on Tuesday. The company has promised to try and redeploy staff to other Healthscope facilities where possible.
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Rehabilitation overtakes childbirth as most common hospital stay for Medibank customers

  • The Australian
  • 12:00AM May 23, 2018

Sarah-Jane Tasker

Rehabilitation treatment has for the first time overtaken childbirth as the most common reason for an overnight hospital stay among insurance giant Medibank’s customers.
The company’s new “health cost and utilisation” report showed that overnight rehabilitation admissions had grown by more than 20 per cent since 2013. The average benefit Medibank paid on behalf of its customers last year for that service was $10,250, an increase of about $1000 in the past five years.
Medibank’s group executive of healthcare and strategy, Andrew Wilson, said the trend was fuelled by the availability of joint replacements and other orthopedic procedures — which accounted for the majority of rehabilitation — for people who in the past may not have had such procedures done.
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IBAC marks Privacy Awareness Week by charging ex-cop with misuse of information

By Stephen Easton • 23/05/2018
Just after one corruption watchdog warned public servants not to peek at government records without good reason in its contribution to Privacy Awareness Week, another laid charges against a former police officer for doing just that.
On Wednesday, Victoria’s Independent Broad-based Anti-corruption Commission charged a former Detective Senior Constable with four counts of unauthorised access, use or disclosure of police information. This is alleged to have taken place last year, and the matter goes to court on July 3.
Incidentally, IBAC’s new chief Robert Redlich has reportedly called for stronger police oversight powers including the ability to search and arrest officers in comments from a private parliamentary hearing leaked to The Age.  Currently, it has to ask other officers to make the arrest, and according to the article, Redlich feels the police cannot always be trusted to keep information confidential.
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Public hospitals billing insurers for treating their members becoming big problem

  • The Australian
  • 9:54AM May 24, 2018

Sean Parnell

Public hospitals billing insurers for the cost of treating their members has been declared one of the biggest problems in the health sector, as new figures show private hospitals experiencing weaker growth in admissions.
After Healthscope announced the closure of two private hospitals in Victoria, and amid ongoing consumer concerns over the value of insurance, Health Minister Greg Hunt has partly laid the blame at State governments for “a semi-privatisation of the public hospital system”.
“We just embarked on the biggest reform in a decade that’s delivered the lowest change in premiums in 17 years,” Mr Hunt said yesterday.
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Out of pocket costs undermining health system

MEDIA RELEASE FRIDAY 25 MAY 2018
Irrespective of whether or not ‘harvesting’ by public hospitals of privately insured patients is occurring, next week’s 4 Corners program on out of pocket costs should alert the private health sector to look at its own cost structures, the Consumers Health Forum says.
The 4Corners Mind the Gap documentary which is expected to demonstrate how high gap costs are undermining the private health system follows the Out of Pocket Pain survey by the Consumers Health Forum which revealed many patients were paying $10,000 or more in out of pocket costs.
“The fact that privately insured patients are getting elective surgery in public hospitals ahead of public patients is a matter of concern and deserves thorough scrutiny,” the CEO of the Consumers Health Forum, Leanne Wells, said.
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'It's outrageous': Doctors slam practice of inflating patient fees

By Kate Aubusson
26 May 2018 — 1:41pm
"Cowardly" specialists charging patients "egregious" out-of-pocket fees have been condemned by delegates at the Australian Medical Association’s national conference in Canberra.
More than 200 doctors gathered on Saturday to debate a draft motion designed to combat inappropriate charges in the guise of “booking fees” and “bill splitting”.
But it was less a debate than unanimous agreement and anger over the practices that gouged patients and damaged the reputation of the entire medical profession.
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International Issues.

China lands bomber on South China Sea island for the first time

20 May 2018 — 11:28am
Beijing: The Chinese air force has landed long-range bombers for the first time at an airport in the South China Sea,  a state newspaper reported on Saturday, in a move likely to further fuel concerns about Beijing's expansive claims over the disputed region.
The China Daily newspaper reported that the People's Liberation Army Air Force conducted takeoff and landing training with the H-6K bomber in the South China Sea.
The Chinese People's Liberation Army Air Force has landed long-range bombers for the first time at an airport in the South China Sea.
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  • May 21 2018 at 1:29 PM

Venezuelan President Nicolas Maduro re-elected amid irregularity claims

by Anthony Faiola
Venezuela's pro-government electoral council declared President Nicolas Maduro the winner of Sunday's election after a vote condemned internationally as the fortification of a dictatorship.
This oil-producing nation is facing a near-total societal collapse because of mismanagement, corruption and a crumbling socialist system, fuelling widespread hunger and medical shortages that have sparked the largest migrant crisis in modern South American history. Traditional opposition parties were barred from fielding candidates, and had called for a broad boycott of Sunday's vote amid fears that Mr Maduro is moving to cement dictatorial power.
"How much have they underestimated our revolutionary people, and how much have they underestimated me," Mr Maduro told a late night crowd in front of the president palace. "And here we are, victorious."
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  • Updated May 21 2018 at 11:33 AM

President Donald Trump backs down on China trade war

Why has US President Donald Trump suddenly backed away, at least temporarily, from threatening a trade war against China?
North Korea was probably a material factor.
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  • Updated May 21 2018 at 11:26 AM

China is winning Trump's trade war

by Heather Long
It was easy to miss the US-China trade statement that the White House released Saturday, right in the midst of royal wedding mania. But it's hard to hide that China looks as if it's winning President Donald Trump's trade skirmish – so far.
The statement said that after several days of talks, the Chinese agreed to "substantially" reduce the United States' $US375 billion trade deficit with China and that the details would be worked out later. It was noticeably vague.
Notice China didn't agree to a specific amount. On Friday, Trump's top economic adviser, Larry Kudlow, was telling reporters that the Chinese had agreed to reduce the deficit by "at least" $US200 billion. China quickly denied that, and, a day later, the official statement didn't have a concrete number, a seeming victory for the Chinese.
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Senator Bob Corker declines Trump offer to be ambassador to Australia

By Patricia Zengerle
22 May 2018 — 10:26am
Washington: US President Donald Trump offered Senator Bob Corker the chance to be the US ambassador to Australia, but the Republican lawmaker, currently chairman of the Senate Foreign Relations Committee, said on Monday he turned the position down.
"At the end of the day, I just felt like it wasn't the right fit and I still had work to do in the Senate," Corker told Reuters in a telephone interview.
The United States has not had an ambassador to Australia, a key US ally in the Pacific, since September 2016. The country is an important US partner on issues ranging from China's military expansionism and North Korea's nuclear program to the conflicts in Syria and Afghanistan.
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While Australia watched a wedding, China was making its next move

By Peter Hartcher
21 May 2018 — 9:16pm
When not busy with a celebrity wedding in a far-off land, Australia and the US have spent recent days preoccupied with problems of trade with China. But have you noticed what the Chinese government has been busy with over the last few days?
For the first time, the People's Liberation Army Air Force on Friday landed heavy bombers on an island in the South China Sea. Three weeks ago it installed anti-ship and anti-aircraft cruise missiles on some of the islands.
The Chinese People's Liberation Army Air Force has landed long-range bombers for the first time at an airport in the South China Sea.
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Australia's Defence Minister condemns 'destablising' move by China to land bombers on new islands

By David Wroe
21 May 2018 — 11:45pm
Defence Minister Marise Payne has condemned Beijing's latest provocation in the South China Sea, branding the decision to land long-range bomber aircraft on an artificial island as "destablising".
The Chinese military has in recent days carried out strike exercises against sea-borne targets before landing on Woody Island in the Paracel group of islands.
It is the first time such large military aircraft have been put on islands China has built on submerged reefs. It follows the recent placement of long-range missiles on the Spratly islands, which are further south and closer to Australia.
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  • May 22 2018 at 1:20 PM

Foreign minister Wang Yi says Australia must take proactive approach to China

China's Foreign Minister Wang Yi has told his Australian counterpart Julie Bishop that Canberra must discard its "traditional thinking" towards China's development and take a more proactive approach to the relationship, but says he has noted efforts by senior ministers to improve ties over the past week.
"If Australia is genuinely hopeful for getting the bilateral relationship back on the right track, Australia should discard its traditional thinking and take off its tinted glasses to take a proactive approach towards China's development," Mr Wang said on Tuesday.
China's Foreign Ministry released a statement with comments from both foreign ministers who met on the sidelines of the G20 meeting in Argentina this week. The statement quoted Ms Bishop as saying the government viewed China's development as a "major opportunity instead of a threat" and negative media reports did not reflect the Coalition's position.
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  • Updated May 22 2018 at 9:38 AM

Julie Bishop holds 'candid' talks with China's foreign minister Wang Yi

Foreign Minister Julie Bishop hs characterised talks with her Chinese counterpart as "warm, candid and constructive", in an indication tensions in the relationship between China and Australia are starting to ease.
Ms Bishop and Wang Yi had a formal bilateral meeting following the conclusion of the G20 foreign ministers' meeting in Buenos Aires, where she raised concerns over China's deployment of a long-range bomber to a disputed territory in the South China Sea but also touched upon trade, cooperation in the Pacific and upcoming North Korea nuclear talks.
Ms Bishop said the meeting, which went for more than an hour, countered claims Australia was in a diplomatic freeze.
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  • Updated May 22 2018 at 12:27 PM

Swedes told to prepare for conflict in Cold War-style booklet

by Daniel Dickson
Sweden will send out instructions to its citizens next week on how to cope with an outbreak of war, as the country faces an assertive Russia across the Baltic Sea.
The 20-page pamphlet titled "If Crisis or War Comes" gives advice on getting clean water, spotting propaganda and finding a bomb shelter, in the first public awareness campaign of its kind since the days of the Cold War.
It also tells Swedes they have a duty to act if their country is threatened. "If Sweden is attacked by another country, we will never give up," the booklet says. "All information to the effect that resistance is to cease is false."
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The public, the political system and American democracy

26 Apr 2018
Description
At a time of growing stress on democracy around the world, Americans generally agree on democratic ideals and values that are important for the United States. But for the most part, they see the country falling well short in living up to these ideals, according to this study of opinion on the strengths and weaknesses of key aspects of American democracy and the political system.
The public’s criticisms of the political system run the gamut, from a failure to hold elected officials accountable to a lack of transparency in government. And just a third say the phrase “people agree on basic facts even if they disagree politically” describes this country well today.
The perceived shortcomings encompass some of the core elements of American democracy. An overwhelming share of the public (84%) says it is very important that “the rights and freedoms of all people are respected.” Yet just 47% say this describes the country very or somewhat well; slightly more (53%) say it does not.
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China's account of 'cool' meeting in contrast to Julie Bishop's

By Kirsty Needham
22 May 2018 — 3:53pm
Beijing: Australia needs to take off its biased, "coloured glasses" and stop recoiling from China for the relationship to "return to the right track", China's foreign ministry has said in a terse statement following a meeting with Julie Bishop.
The Chinese version of events stands in stark contrast to Ms Bishop's account of the same meeting, which she described as "very warm and candid and constructive".
According to a cool statement from China, released on Tuesday afternoon in Beijing, Foreign minister Wang Yi told Ms Bishop when they met in Argentina on Monday that it was "not an official bilateral meeting", but rather he wanted to "exchange views with you on bilateral relations".
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Misogyny and misplaced outrage

By Michelle Thompson
21 May 2018 — 4:51pm
As the world watched the wedding of Meghan Markle and Prince Harry with delight, the community of Santa Fe, Texas, mourned the death of 10 children, the latest victims of yet another school shooting.
It seems like every month another school shooting takes the lives of more innocent children. While survivors of communities like Santa Fe pick up the pieces, US politicians are quick to point their fingers at anything and everything as a reason for why it happened. Anything and everything, that is, apart from gun control.
Following this latest shooting, Texas Governor Dan Patrick blamed violent video games, movies, family break-ups and even bullying on social media for the reasons why these mass shootings take place. What is most galling, however, is that he also blamed abortion for devaluing human life and spurring the same shootings.
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Ukraine paid Trump lawyer Cohen to arrange White House talks: BBC

24 May 2018 — 8:23am
London: US President Donald Trump's personal lawyer, Michael Cohen, received a secret payment of at least $US400,000 to arrange talks between Trump and Ukrainian President Petro Poroshenko last year, the British Broadcasting Corp reported on Wednesday.
The payment was arranged by intermediaries acting for Poroshenko who wanted to open a back channel to the Republican US president, the BBC said, citing unnamed sources in Kiev.
Cisco Systems has warned that hackers have infected at least 500,000 routers and storage devices in dozens of countries with highly sophisticated malicious software, possibly in preparation for another massive cyber attack on Ukraine.
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  • May 25 2018 at 12:00 AM
  • Updated 28 mins ago

Donald Trump cancels meeting with North Korea's Kim Jong Un

US President Donald Trump cancelled a planned historic summit with North Korea's leader Kim Jong Un, warning that the "most powerful military in the world" was on standby and harsh economic sanctions against Pyongyang would intensify.
Surprising the world, President Trump wrote a letter to chairman Kim explaining that North Korea's "tremendous anger and open hostility" towards the US this week meant the meeting in Singapore next month could not go ahead.
However, Mr Trump held out an olive branch to Mr Kim by noting that "some day, I very much look forward to meeting you" to negotiate denuclearising the Korean peninsula.
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Now everything just got worse with North Korea

By Nicholas Kristof
25 May 2018 — 10:30am
Now we enter a more dangerous period in relations with North Korea.
President Donald Trump topped a particularly inept diplomatic period by canceling his summit with North Korean leader Kim Jong-un. The previous policy of maximum economic pressure on North Korea may no longer be viable, so the risk is that Trump ends up reaching for the military toolbox.
As every president since Richard Nixon — except for Trump — has realised, the military options are too dangerous to employ. That’s even more true today, when North Korea apparently has the capacity to use nuclear, chemical and biological weapons against Seoul, Tokyo and perhaps Los Angeles.
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Irish voters set to liberalise abortion laws in landslide

By Padraic Halpin and Graham Fahy
26 May 2018 — 8:57am
Dublin The people of Ireland are set to liberalise some of the world's most restrictive abortion laws by a landslide, an exit poll showed on Friday, as voters demanded change in what two decades ago was one of Europe's most socially conservative countries.
The Irish Times/Ipsos MRBI exit poll suggested that voters in the once deeply Catholic nation had backed a referendum by a margin of 68 percent to 32 percent.
Emotions ran high as people in Ireland headed to the polls to decide whether to lift the country's controversial ban on abortion.
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'This is just the start': China-Australia tensions brought to the surface

By Nick O'Malley
25 May 2018 — 11:59pm
On Monday morning Foreign Minister Julie Bishop was in Buenos Aires, about 20,000 kilometres from Beijing, doing her best to repair Australia’s tattered diplomatic relationship with China.
Back in Australia, something like all-out war had broken out between the opposing factions in the debate over the nature of that relationship - groups that have come to be unhelpfully lumped together as either China hawks or panda huggers.
Days earlier a leading figure of the latter group, Geoff Raby, a former Australian ambassador to China, had declared in a column for The Australian Financial Review that Bishop should be sacked and replaced with someone more up to the job of managing the crucial relationship.
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I look forward to comments on all this!
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David.

Another Issue The Proponents Of The myHR Need To Face. Lack Of Data Accuracy.

This appeared last week:

Should you trust what e-records tell you?

22 May 2018
GPs are repeatedly told that electronic medical records will fix the problems of faulty memories, illegible hospital handover notes and patients who aren’t faithful to one GP (but don’t tell you). But do you trust what your computer says?
Researchers from Perth read the electronic patient records of almost 1000 patients and then checked with the real-life patient if they were accurate.
The results focused on whether patients had received their flu vaccination or not. These searches found that, in 84% of cases, the electronic records and the patients’ memories were the same. However, in 16% of cases, the computer said no but the patient said yes — or the other way around.
The first scenario was more common by a fair stretch (the patient said they had been vaccinated, but it wasn’t on their electronic patient record).
As the researchers from the WA Department of Health pointed out, this might be because they had the vaccination at work or a pharmacy, so it was easily missed.
They also looked at the accuracy of electronic records covering the presence of diabetes, asthma, chronic heart disease or pregnancy.
They found that concordance was highest for diabetes (96%), then heart disease (92%), pregnancy (90%) and asthma (89%).
More here:
What this article is telling you is that the source articles for the myHR have very significant omissions and errors – so just how useful is it to try and use such inaccurate records in an aggregate sense. Not very would be my feeling.
More useful would be to design a program to improve the accuracy of the records we have. I suspect that would be more useful than gathering all these erroneous records together and trying to make something of them!
BTW – does anyone have the source paper – some my like to read it I suspect and I can’t find it.
David.

Wednesday, May 30, 2018

The New York Times Points Out How Useless The myHR Will Be For Serious Clinical Research.

This appeared a few days ago.

New Cancer Treatments Lie Hidden Under Mountains of Paperwork

May 21, 2018
Dr. Nikhil Wagle thought he had a brilliant idea to advance research and patient care.
Dr. Wagle, an oncologist at the Dana Farber Cancer Institute in Boston, and his colleagues would build a huge database that linked cancer patients’ medical records, treatments and outcomes with their genetic backgrounds and the genetics of their tumors.
The database would also include patients’ own experiences. How ill did they feel with the treatments? What was their quality of life? The database would find patterns that would tell doctors what treatment was best for each patient and what patients might expect.
The holdup, he thought, would be finding patients. Instead, the real impediment turned out to be gathering their medical records.
In the United States, there is no single format used by all providers, and hospitals have no incentive to make it easy to transfer records from one place to another. The medical records mess is hobbling research and impeding attempts to improve patient care.
“Data are trapped,” said Dr. Ned Sharpless, director of the National Cancer Institute. “This is a huge problem. It is phenomenally important.”
The cancer institute has invested millions of dollars into determining the genetic sequences of patients’ tumors, and researchers have found thousands of genes that seem to drive tumor growth.
But until patients’ medical records are linked to the genetic data, life-or-death questions cannot be answered.
“What drug did they get? Did they respond? Did they survive? Were they cured?” Dr. Sharpless asked.
The federal government has mandated uniform standards for electronic health records. “At this point, they are not to a level that helps with the detailed clinical data that we need for the scientific questions we want to ask,” Dr. Wagle said.
A few private companies are trying to tackle the problem. Flatiron Health, just bought by Roche, has obtained about 2.2 million records of cancer patients from medical centers and made them available for research after stripping them of identifiable information.
But Flatiron must employ 900 nurses and certified tumor registrars, people with master’s degrees in coding data, to put it all into a usable form.
“About 50 percent, if not more, of the critical details we need for research are trapped in unstructured documents,” said Dr. Amy Abernethy, the company’s chief medical officer.
“They are in PDFs. Maybe a doctor put in a note by hand, maybe a doctor typed it. That note became a narrative. It is not something that can easily be put into a spreadsheet.”
Dr. Sharpless worries that the data acquired by companies like Flatiron will not be readily available to researchers. But if the companies manage to solve the medical records problem cheaply, he said, “we’d like to work with them to figure out how to liberate the data.”
Dr. Wagle is making data from medical records and patients’ experiences public as he gets them. After 2 1/2 years, though, he is disappointed by how little there is to share.
The patient who inspired his project had a lethal form of thyroid cancer. She was expected to die in a few months. In desperation, doctors gave her a drug that by all accounts should not have helped.
To everyone’s surprise, her tumors shrank to almost nothing, and she survived. She was an “extraordinary responder.”
Vastly more here:
Much the same with the “data are trapped” will happen with the myHR
The myHR, as we all know, is a mountain of .pdfs with some atomic data and images etc. to handle pathology and imaging results. The closest to atomic data will be the medicines data I would suspect.
Data at the level described above may be partially captured but will more than likely only even be partially available in practice systems.
Sadly I suspect the solution of re-entering the important data is going to be the only viable one as it has turned out to be in the U.S. at a cost I suspect no one will be able to afford.
So, what sounds really simple turns out to be just too hard!
David.

Maybe Real Time Prescription Monitoring Is Not All It Is Cracked Up To Be.

This week we have had more calls for prescription monitoring:
See here:

Queensland needs real-time prescription monitoring 'urgently', coroner says, amid opioid deaths

A prescription monitoring system to prevent "doctor shopping" in Queensland is needed urgently within the next two years, rather than the state waiting for a national scheme to come online, an inquest into four opioid deaths has found.
Coroner James McDougall examined the deaths of William House, Jodie Anne Smith, Vanessa Joan White and Daniel Keith Milne between 2012 and 2014.
Medical bodies including the Australian Medical Association and the Pharmacy Guild have repeatedly called for a real-time monitoring system to be introduced in Queensland to prevent addicts from visiting different doctors to collect multiple opioid prescriptions.
There are already moves towards a national monitoring system, after Federal Health Minister Greg Hunt announced $16 million in funding for one last July.
But Mr McDougall said Queensland Health should look to implement its own real-time tracking system "urgently" — definitely within two years.
"The number of deaths that will occur in the interim whilst implementation is taking place is alarming," he said.
"Coronial statistics indicate an annual death toll from prescription opioids approaching 1,500 people each year and increasing.
"Given the growing epidemic associated with opioid misuse, the states and territories need to take responsibility for addressing the increasing issues associated with the prescribing, dispensing and monitoring of drugs of dependence."
The coroner also said more education was needed for doctors prescribing schedule 8 medicines.
More here:
and here:

 ‘Urgency’ to implement real-time script monitoring: coroner

An inquest into four deaths related to opioid prescribing and doctor shopping has highlighted the urgent need for real-time monitoring

A joint inquest into four recent deaths was recently held in the Coroners Court of Queensland with the aim to consider the issues associated with misuse of opioid prescription medication in Queensland and, more broadly, Australia.
Coroner James McDougall explored the circumstances surrounding the deaths of William House, 30 years old at the time of his death; Jodie Anne Smith, 41 years old at the time of her death; Vanessa Joan White, 38 years old at the time of her death; and Daniel Keith Milne, 40 years old at the time of his death.
Each of the patients had participated in doctor shopping in the lead up to their deaths, and in several instances had been able to gain access to large amounts of OxyContin and fentanyl from various doctors at different medical practices, sometimes on the same day or within days of the last prescription.
This was in addition to sometimes being supplied opioids after presenting at hospital emergency departments.
More here:
But then this appears:
Reviews |8 May 2018

Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses: A Systematic Review

David S. Fink, MPH; Julia P. Schleimer, BS; Aaron Sarvet, MPH; Kiran K. Grover, BA; Chris Delcher, PhD; Alvaro Castillo-Carniglia, PhD; June H. Kim, PhD; Ariadne E. Rivera-Aguirre, MPP; Stephen G. Henry, MD; Silvia S. Martins, MD, PhD; Magdalena Cerdá, DrPH

Abstract


Background:
Prescription drug monitoring programs (PDMPs) are a key component of the president's Prescription Drug Abuse Prevention Plan to prevent opioid overdoses in the United States.
Purpose:
To examine whether PDMP implementation is associated with changes in nonfatal and fatal overdoses; identify features of programs differentially associated with those outcomes; and investigate any potential unintended consequences of the programs.
Data Sources:
Eligible publications from MEDLINE, Current Contents Connect (Clarivate Analytics), Science Citation Index (Clarivate Analytics), Social Sciences Citation Index (Clarivate Analytics), and ProQuest Dissertations indexed through 27 December 2017 and additional studies from reference lists.
Study Selection:
Observational studies (published in English) from U.S. states that examined an association between PDMP implementation and nonfatal or fatal overdoses.
Data Extraction:
2 investigators independently extracted data from and rated the risk of bias (ROB) of studies by using established criteria. Consensus determinations involving all investigators were used to grade strength of evidence for each intervention.
Data Synthesis:
Of 2661 records, 17 articles met the inclusion criteria. These articles examined PDMP implementation only (n = 8), program features only (n = 2), PDMP implementation and program features (n = 5), PDMP implementation with mandated provider review combined with pain clinic laws (n = 1), and PDMP robustness (n = 1). Evidence from 3 studies was insufficient to draw conclusions regarding an association between PDMP implementation and nonfatal overdoses. Low-strength evidence from 10 studies suggested a reduction in fatal overdoses with PDMP implementation. Program features associated with a decrease in overdose deaths included mandatory provider review, provider authorization to access PDMP data, frequency of reports, and monitoring of nonscheduled drugs. Three of 6 studies found an increase in heroin overdoses after PDMP implementation.
Limitation:
Few studies, high ROB, and heterogeneous analytic methods and outcome measurement.
Conclusion:
Evidence that PDMP implementation either increases or decreases nonfatal or fatal overdoses is largely insufficient, as is evidence regarding positive associations between specific administrative features and successful programs. Some evidence showed unintended consequences. Research is needed to identify a set of “best practices” and complementary initiatives to address these consequences.
Primary Funding Source:
National Institute on Drug Abuse and Bureau of Justice Assistance.
http://annals.org/aim/article-abstract/2680723/association-between-prescription-drug-monitoring-programs-nonfatal-fatal-drug-overdoses?doi=10.7326%2fM17-3074
The summary review in Journal Watch said in a comment:
“Results of this systematic review are tempered by the observational design of the included studies, moderate-to-high risk for bias in nearly all the studies, and heterogeneity of PDMP features among states (e.g., some states require clinicians to review PDMP data when prescribing narcotics, whereas others do not; similarly, not all states share data). Editorialists emphasize that, although PDMPs probably will curb prescription opioid supplies in U.S. communities, these same communities also require efforts to address heroin and other illegal drug supplies and initiatives to engage patients in drug-treatment programs.”
See here:
So what is clear here is that not only do you need prescription monitoring but you have to do it right. The full paper provides some tips as to what ‘right’ may look like!
Clearly worth a read.
David.

Tuesday, May 29, 2018

Has The ADHA Lost Its Social License To Try To Give Us All A myHR?

This article appeared last week:

It’s time to put consumers in the driver’s seat in Big Data economy

By Lauren Solomon • 21/05/2018
If the public doesn’t feel it can say no, all the privacy policies and terms and conditions can’t solve society’s data governance woes.
The Australian government has allocated $44.6 million over four years in this year’s budget to establish the new Consumer Data Right (CDR). This investment is slated to support the ACCC, OAIC and CSIRO to establish appropriate rules and standards and to ensure the impacts of the CDR are consistent with the Privacy Act.
This is a welcome step, because our latest research uncovers the yawning gap between public expectation and current practices when it comes to data collection, sharing and use.
In a survey of 1004 Australians conducted for the Consumer Policy Research Centre by Roy Morgan Research from March to April this year, 94% of those surveyed did not read the privacy policies or terms and conditions for all the products they signed up to in the past 12 months.
For those who had waded their way through at least one lengthy, complex, privacy policy — two-thirds accepted the terms even though they felt uncomfortable, and 73% did so because it was the only way they could access the product or service.
It’s the presumed consent to these policies which often allows consumer data to be captured, transferred, on-sold or transformed for other purposes well beyond what any consumer could have reasonably expected. The policies can also change, making it difficult to know what we consented to in the first place.
Some 70% of survey respondents were not comfortable with their basic data, such as their purchase histories and location data, being shared; while more than 85% were opposed to companies sharing more personal information, like their phone contacts and text message logs.
Yet all of this information is regularly captured and used for personalising ads, offers and sponsored content on digital platforms and mobile apps, and, despite their concerns, most consumers reported continuing to use these digital products and services.
Much innovation, efficiency and consumer benefits arise from data analysis, collection and sharing. We need to ensure this is being done responsibly. This means putting consumers, not companies, in the driver’s seat when it comes to their data.
This also means striking the balance right between encouraging innovation, protecting privacy and enabling consumer choice.
Lots more here:
Almost at the same time we see this press release:

Health report confirms: consumers want control of their own health data

Australians want ownership and control of their own health data and want to be asked for consent when their data is used by government, private companies or researchers. 

This stand-out finding was revealed today in the Engaging Consumers in their Health Data Journey Report jointly published by Consumers Health Forum and NPS MedicineWise. The comprehensive report was generated through qualitative interviews, literature reviews, a round table discussion with key stakeholders and consumer representatives, and a nationally representative survey of 1,013 Australians.
Survey results gave the clearest indication that Australians want control over their health data, with 96% of Australians believing they should have access to their own health data and 90% of respondents agreeing they should be asked for permission if either a government department or a private organisation wants to use the data.
The research found that consumers are more likely to give permission to share their data if they understand how their data will be used and any benefits that will come from its use. Almost two-thirds (62.5%) of survey respondents said they would be comfortable with the Government using their data to support health care providers to improve the care of others in the community. The report also revealed that consumers are more willing to share their data when it is for public or individual good, and are significantly less likely to share it if the use is for commercial gain. That said, privacy is a real issue, with nearly two thirds (64.8%) of respondents stating they believe sharing their data is acceptable if they are not identified and just one in five (21.8%) comfortable with their data being shared if they are identified.
Dr Lynn Weekes, CEO of NPS MedicineWise says, “Developing models of consent that are both acceptable to consumers and feasible for research and health communities should be considered a key challenge and priority. The onus is on organisations to put in place clear, transparent, open and two-way communications about how and by whom their data will be used, along with the benefits and any risks. Again, involving consumers in designing these communications will ensure they meet consumers’ needs, building their trust and willingness to share data.”
The Consumers Health Forum of Australia (CHF) was commissioned by NPS MedicineWise in December 2016 to conduct research about consumers’ attitudes to health data. The project and resulting reports were developed collaboratively.
The publication of this survey coincides with the Australian Government’s release of a framework for how data in the My Health Record System can be used and protected for public health and research purposes.
“My Health Record data will be available on a de-identified basis for use by policy makers and researchers to make evidence-based decisions about new health policies and programs to the benefit of consumers. Consultation that shaped the framework highlighted how important it is for the community to have their health care information kept private with the right protections and safeguards in place” says Leanne Wells, CEO of the Consumers Health Forum.
“Without that trust and confidence we know from this research this will negatively influence consumers’ willingness to consent to the use of their data. It is heartening to see that the findings of the research are reflected in the framework, particularly that My Health Record data should not be used for commercial or non-health related purposes, such as determining eligibility for welfare benefits, insurance assessments and direct marketing to consumers.”
The report highlights population sub-groups with specific concerns about data use that will require appropriate consultation and involvement. These include Aboriginal and Torres Strait Islander consumers, cultural groups, consumers who have had experiences that impact on their levels of trust and those who are concerned about discrimination due to mental health or other health issues.
The full report is available for review below.
Date published : 23 May 2018

Media enquiries

NPS MedicineWise

Eve Hanks:
  • 0419 618 365
  • ehanks@nps.org.au
Independent, not-for-profit and evidence-based, NPS MedicineWise enables better decisions about medicines, medical tests and other health technologies. We receive funding from the Australian Government Department of Health.

Consumers Health Forum of Australia

Mark Metherell:
  • 0429 111 986
  • M.Metherell@chf.org.au
CHF is Australia’s leading advocate on consumer health care issues.
We work to achieve safe, good quality, timely healthcare for all Australians, supported by the best health information and systems the country can afford
----- End Release.
It is really striking to see the alignment of what people seem to be asking for and what the Europeans have achieved in the GDPR.
Dr Katharine Kemp usefully summarises the GDPR rules in the following way and looks forward to what we may want in OZ..
“The EU General Data Protection Regulation (GDPR), which comes into effect on 25 May 2018, provides one model for improved consent. Under the GDPR, consent:
… should be given by a clear affirmative act establishing a freely given, specific, informed and unambiguous indication of the data subject’s agreement.
The Privacy Act should be amended along these lines to set higher standards for consent, including that consent should be:
·         explicit and require action on the part of the customer – consent should not be implied by the mere use of a website or service and there should be no pre-ticked boxes. Privacy should be the default;
·         unbundled – individuals should be able to choose to consent only to the collection and use of data essential to the delivery of the service, with separate choices of whether to consent to additional collections and uses;
·         revocable – the individual should have the option to withdraw their consent in respect of future uses of their personal data at any time. “
See here:
It is clear just how un-conformant with these a large opt-out database like the myHR is, and how it no longer fits the present mood for specific consent etc..
I suspect the demand for the changes suggested have accelerated recently because of the scandals around Facebook and Equifax but have been underway for a few years and that the time for the myHR opt-out plan has passed. Realistically it may still happen, but I suspect it may later be wound back as it is found not to be all that clinically useful, to offer poor value for money and a few horror stories of information leaks etc. emerge.
I believe the times are a’changin and the myHR is an idea of another, past time as these surveys highlight.
David.

Postscript:

It is worth noting similar sentiments were set out in this week's Economist.

Here is the link:

https://www.theaustralian.com.au/news/inquirer/eu-law-reflects-belated-public-interest-in-privacy/news-story/f4f768206da7e87848b88f9282cb3529

D.

Senate Estimates Alert: - Today 9.45am - 11am The NHMRC and ADHA

Here is the link to the program etc:

https://www.aph.gov.au/Parliamentary_Business/Senate_Estimates/ca

David.