Quote Of The Year

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

or

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

Thursday, January 03, 2019

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

January 03, 2019 Edition.
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It is hard to know where to start. Increasingly you have to wonder if the Trump has ‘slipped his moorings’  with market turmoil, shutdowns, withdrawals and complaining of being ‘all alone in the Whitehouse’. It is just not getting better!
Brexit is ISQ this week.
In OZ we have the failed PM (Dutton) having a go at one real on who lasted a few years (Turnbull). Means it is a pretty slow news period! Barnaby is attacking Labor in the right-wing press and everyone else seems to be on holidays!
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Major Issues.

Credit gluttons will be the financial roadkill of 2019

As the Fed raises borrowing costs for the fourth time this year, patience, prudence and preservation of capital should take high priority.

Peter Warnes
Dec 21, 2018 10:16:00 AM

Introduction

I reiterate my recommendation in Forecast 2019 that cash should be a real asset class in 2019, not a balancing item in a portfolio. I will be comfortable with a higher cash holding, rather than be tempted to allocate it to a risky or overvalued investment. Patience, prudence and preservation of capital should have high priority.
A flattening yield curve is a reasonable forward indicator of market volatility. As it flattens the more anxious investors become about the outlook for economic growth. So, batten down for more volatility in 2019, perhaps beyond. The US 2-year (2.65%) and 5-year (2.62%) yields are marginally inverted at present and the one-year and 5-year yield are the same at 2.62%. Volatility is the new normal. Credit-reliant companies that have had a free ride on the coat tails of massive central bank easing over the past eight or nine years are likely to be the road kill of financial markets in 2019.
It has been well documented we are in the late stages of the current economic cycle, which was extended due to the prolonged rescue operations of the central banks in the aftermath of the GFC. The magnitude of the stimulus programs was unparalleled in both quantum and duration. Already in 2018 US corporates outlaid a record US$1 trillion in buybacks, easily exceeding the previous record of US$781bn in 2015. These purchases have supported US markets in 2018 helping them to record levels and this could be viewed as a misallocation of capital, at least in the short-term.
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Lenders crack down on off-the-plan buyers as property market tumbles

21 Dec 2018 — 11:00 PM
Developers and off-the-plan purchasers are being squeezed as lenders double down on credit by intensifying scrutiny of borrowers coming up for final loan assessments, despite having received conditional approval.
Conditions are tightening as homes bought off the plan at the peak of the real estate boom two or three years ago are coming up for completion in a market where values and rentals are falling in major cities.
Tough new lending conditions and falling property values mean more deals are being knocked back, forcing borrowers to find other lenders or face legal action and loss of deposits paid to developers.
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'Tis the season for Coalition MPs to contemplate life after politics

By Sean Kelly
23 December 2018 — 2:48pm
In the lead-up to the 2013 election, after six years in government, there was resignation in Labor ranks – quite literally. Julia Gillard, Simon Crean, Nicola Roxon, Greg Combet, Chris Evans, Stephen Smith, Craig Emerson, Peter Garrett, Martin Ferguson and Robert McClelland all announced they would not be staying on. There were others – I’ve listed only the former cabinet ministers.
The situation is not identical to that facing the Coalition in 2019, after six years in government, but it’s not so far off. On Tuesday, MPs will sit down with their families over the Christmas pav, and ask themselves whether they can really take more years of this – most of them in opposition. Some decisions might not be announced until after the election, but they will likely be made over the next weeks.
The decision might be personal. The outcome won’t be. Who retires and who sticks around will help determine who wins the god-almighty ideological fight that will consume the Liberals over the next three years, a battle that will be as important to the future of Australian politics as the performance of the Shorten government. My bet is on the moderates, who must now be realising just how ill-judged were their efforts to play nice with the party’s psycho-killer wing.
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PM urges voters to 'get shopping' as retailers sweat on last-minute sales

By Matt Bungard & Eryk Bagshaw
23 December 2018 — 3:38pm
The Morrison government has urged people to get out and shop in the final day before Christmas, as retailers sweat on a positive end to a torrid year and the Coalition banks on a big spending summer to drive its April budget.
Sluggish household consumption figures have been the dumbbell weighing down Australia's economic growth over the past year, as consumers shut their wallets thanks to the triple threat of low wage growth, falling house prices and rising energy costs.
The lack of spending has an impact not just on individual shops, but also the government's revenue – revising down GST collections by $5.8 billion over four years in December's mid-year economic update.
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Australian troops to stay in Middle East despite US pullout: Morrison

By Eryk Bagshaw
23 December 2018 — 5:17pm
Australian troops will remain in the Middle East despite US President Donald Trump announcing the withdrawal of thousands of soldiers from Syria and Afghanistan in a move that has shocked his Western allies and forced the sudden resignation of his Defence Secretary, Jim Mattis.
Prime Minister Scott Morrison said Australia's presence "will remain" in the region, where more than 600 troops continue to conduct operations and train local troops in Iraq and Afghanistan.
"We have to be conscious of the potential for a resilient and a resurgent [Islamic State]," he said.  "We're in regular dialogue, we're engaging with the US about what their plans are and to ensure there can be some alignment with both their thinking and planning."
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How to get more bang from your bucks: go on more holidays

By Ross Gittins
24 December 2018 — 12:00am
They say people who think money doesn’t buy happiness just don’t know where to shop. Sorry to have left it so late in your preparations for Christmas and summer, but on this score I have breaking news.
It’s a funny thing that, though economists hold consumption to be the “soul end and purpose” of all economic activity, it’s not a subject that greatly interests them. They’ll help you maximise how much you’ve got to spend, but they’ll give you no help in deciding how to spend it in a way that yields the most happiness – or, as they prefer to say, “satisfaction”.
No, for advice on how to get the biggest bang from your bucks, the experts are social psychologists.
For the past 15 years, their prevailing wisdom has been that spending on experiences – from an overseas holiday to a trip to the movies – yields more happiness than buying more stuff.
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We’re ready for a fresh al-Qa’ida threat: ScoMo

  • 12:00AM December 24, 2018
Scott Morrison says Australia is working to counter the renewed dangers posed by Islamic terrorism, amid reports of a fresh al-Qa’ida threat to commercial jets and fears the US could spark an Islamic State resurgence through its withdrawal from key Middle East hot spots.
The Prime Minister said Australia was not complacent about the potential for a resurgence by al-Qa’ida, which the British government has warned is developing new technology — including miniaturised bombs and drones — to bring down passenger jets.
“Whether it’s al-Qa’ida, or whether it’s Daesh, or whether it’s Jemaah Islamiah, or any of the other radical extremist, violent Islamic groups that would seek to do Australia harm, our government can always be relied upon,” Mr Morrison said.
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The world will pay for not dealing with debt

By Satyajit Das
24 December 2018 — 11:59am
Markets, to paraphrase Nobel prize-winning economist Thomas Schelling, often forget that they keep forgetting. That's especially true when it comes to the intractable challenges posed by global debt.
Since 2008, governments around the world have looked for relatively painless ways to lower high debt levels, a central cause of the last crisis. Cutting interest rates to zero or below made borrowing easier to service. Quantitative easing and central bank support made it easier to buy debt. Engineered increases in asset prices raised collateral values, reducing pressure on distressed borrowers and banks.
All these policies, however, avoided the need to deleverage. In fact, they actually increased borrowing, especially demand for risky debt, as income-starved investors looked farther and farther afield for returns. Since 2007, global debt has increased from $US167 trillion ($237 trillion) ($US113 trillion excluding financial institutions) to $US247 trillion ($US187 trillion excluding financial institutions). Total debt levels are 320 per cent of global GDP, an increase of around 40 per cent over the last decade.
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What's got oil so spooked? It's the economy, stupid

By Julian Lee
24 December 2018 — 11:26am
It wasn't meant to be like this.
Not only are oil prices down nearly 40 per cent since early October, they're below where they were when the OPEC+ group of producers began their first round of output cuts in January 2017.
There are two main factors behind this pessimism. The first stems from an undue scepticism about the group's willingness to trim output. The second follows from a negative view about the global outlook that is subject to change – and if it does, a sharp rebound is in store.
The recent Russian-brokered deal to cut around 1.2 million barrels a day from global supply in January should have put a floor under prices. Their drop suggests traders don't believe the cuts will be implemented.
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Australia on track to miss Paris emissions targets by huge margin

By James Fernyhough
Updated 21 Dec 2018 — 6:06 PM, first published at 12:08 PM
Australia is on track to miss its Paris greenhouse gas emissions reduction targets by 19 percentage points, a slight improvement on 2017 projections but still drastically short of its commitments, new government figures reveal.
Under the Paris agreement, Australia has committed by 2030 to reduce greenhouse gas emissions by 26 per cent to 28 per cent on 2005 levels. The latest projections, released on Friday morning by the Department of the Environment and Energy, show Australia is on track to reduce its emissions by just 7 per cent on 2005 levels by 2030.
For the 26 per cent reduction to be met, Australia's net greenhouse gas emissions would need to be no more than 4800 megatonnes of carbon dioxide or equivalent greenhouse gases (Mt CO²-e) by 2030. On current projections the nation's emissions will be 5487 Mt CO²-e by 2030, 687 MtC0²-e short of the target.
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RBA'S Michele Bullock discusses the country's housing woes

22 Dec 2018 — 11:00 PM
Michele Bullock could be excused for feeling the pressure as jeremiads about the Australian property market swirl all around her.
But when she sits down with The Australian Financial Review for a wide-ranging interview about the country's housing market, the woman who heads the Reserve Bank's financial stability area is disarmingly warm, direct and engaging. There's no sign of tetchiness or defensiveness when she discusses the doomsday predictions that the downturn in the housing market will plunge the entire Australian economy into recession.
Instead, Bullock observes how worries about the property market have undergone a 180-degree turn in a remarkably short time.
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An optimist's guide to investments in 2019

By Andrew McAuley
26 Dec 2018 — 12:00 AM
It's natural at this time of the year for investors to stick their heads up above the parapet, reflect on the wins and losses of 2018 and start mapping out expectations for the coming year. With markets taking on a distinctively bearish tone since September, it is all too easy to focus on the negatives.
There will be many espousing the end of the equities boom and forecasts of continued doom and gloom in global markets. In early September I wrote we were approaching the peak for equities as indicated by the bond market. Since then shares in developed markets have fallen by more than 10 per cent, which is the accepted definition of a correction. But I also said we were actually mildly positive for 2019. We maintain that view, which is now underpinned by better value in equities. So what needs to go right for our view to prevail? We have identified six key factors which may extend the global cycle next year.
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'Extremely disappointed': Australia lashes Japan's decision to restart commercial whaling

By Fergus Hunter & Steve Jacobs
Updated26 December 2018 — 4:00pmfirst published at 1:48pm
The Australian government has condemned Japan's "regrettable" decision to withdraw from the International Whaling Commission and resume commercial whaling.
The Japanese government's withdrawal from the global body, announced on Wednesday, will see commercial hunts in the country's territorial and economic waters start in July 2019.
Announcing the decision, Chief Cabinet Secretary Yoshihide Suga also said Japan would end its so-called "scientific" hunts in the Southern Ocean, operations that have for years caused tension between Tokyo and Canberra.
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The volatile outlook for 2019 is a reflection of Trump's America

By Stephen Bartholomeusz
27 December 2018 — 12:36pm
Despite the dramatic Boxing Day bounce in the US, the closing months of 2018 have been stressful for investors accustomed to a market environment that had been remarkably calm within a bullmarket that began in March 2009. The intense volatility seen since September may, however, be a foretaste for what’s to come.
The surge in the Dow Jones Index – more than 1000 points – was the single biggest one-day move in its history and the 4.96 per cent rise in the S&P 500 its largest gain since the post-crisis market bottomed in March 2009.
The US market has, however, fallen 15.8 per cent since the start of the year (it was down 19.8 per cent before Wednesday 4.96 per cent spike) while the Australian market is trading about 13.5 per cent lower than it began the year.
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Tyranny of distance: The renewable power disconnect

By Cole Latimer
27 December 2018 — 12:00am
The renewable energy boom may be going to waste because the best place to put wind and solar is too far away to connect to the grid.
Australia has seen a major transition of its energy sector as it moves away from traditional coal and gas-fired power to include more wind, solar and hydro power but the existing network has not evolved to keep pace and consumers could bear the costs.
The large number of new renewables means many are either unable to connect to the grid due to the sudden congestion from excess power being generated at the same time or just a complete lack of transmission to push the power into the grid.
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Warren Buffett says there are only 2 things you need to do when shares fall

By Tanza Loudenback
28 Dec 2018 — 8:12 AM
Stocks may be teetering on the brink of a bear market, but now is not the time to panic.
While the Dow and S&P 500 are both on track for the worst losses in a decade, as Business Insider's Callum Burroughs reported, it's important to remember the oft-repeated advice of Warren Buffett: "Be fearful when others are greedy and greedy only when others are fearful."
As MoneyTalksNews reported, Buffett, the billionaire investor and founder of Berkshire Hathaway, reiterated some of his best advice for sustaining wealth during a bear market in his 2016 letter to shareholders: stay in the market and buy at a bargain.
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Wall Street's epic rally is not how sharemarket ride ends

Updated 27 Dec 2018 — 6:27 PM, first published at 6:15 PM
President Donald Trump's Plunge Protection Team didn't have to do a thing.
A sensational rally on Wall Street sparked by the President's assurance that the chairman of the Federal Reserve's job is safe, and Amazon's declaration of successful holiday sales, was enough to save the S&P 500 from crossing into a bear market.
The Dow Jones Industrial Average staged a record rally in points terms, advancing 1086 points or 4.98 per cent, and the S&P 500 116 points or 4.96 per cent on Wednesday. The Nasdaq rose almost 6 per cent in a strong session by FAANG stocks: Amazon added almost 10 per cent despite its vague market statement, Facebook and Netflix more than 8 per cent, Apple 7 per cent, and Alphabet 6 per cent.
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Back to brute force politics as Washington quits the field

Updated 27 Dec 2018 — 6:13 PM, first published at 5:15 PM
In a year of political upheaval, domestic and international, there were fewer more troubling images than that at the G20 in Argentina when two tyrants, Russia's Vladimir Putin and Saudi Crown Prince Mohammed bin Salman, openly smiled, laughed and greeted each other with a high five.
It was a moment that symbolised a complete lack of global moral leadership created by the creeping economic, diplomatic and military withdrawal by the United States under the increasingly unhinged "leadership" of Donald Trump, the man Kim Beazley once so aptly described as a narcissistic buffoon.
The mocking defiance in Buenos Aires in early December demonstrated that you could murder journalists and critics, invade your neighbour, shoot down a civilian airliner, back a regime that used chemical weapons, or poison your enemies, perceived or otherwise, on foreign soil – without any real consequence.
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Scott Morrison will have to dig deep next year

27 Dec 2018 — 11:45 PM
A seven-point gap in the opinion polls, and dependent on seven cross-benchers to stay alive for a day in Parliament: Scott Morrison faces re-election in a few months with depleted stocks of everything, except ironically of money.
A strong economy has delivered 1.2 million jobs since the Coalition took office, and the end of a decade of deficits is in sight. In the last six months, a windfall company tax take has delivered another $31 billion to the government's coffers. But Mr Morrison now has to turn cash into votes, when few governments have much track record of doing that wisely. On top of new spending promises over the last six months, the government has flagged in the Mid-Year Economic and Fiscal Update another $9.2 billion in tax cuts ahead of the election.
Even then, Mr Morrison still has to politically out-pledge Labor's war chest of twice the size, because the Coalition will not increase taxes while Labor will strip what it needs from property investors and retirees. Then Australia might face a year of political transition at the same time as the world economy slows, its synchronised recovery long over. That's not the same as living with the anxiety of Brexit on March 29 next year, or waiting for the next bombshell from the White House. But Australia no longer has a budget buffer to deal with what global shocks may come. And at home, a government of either stripe will have to steer through more falls in house prices, a more politically sensitive market than ever when household debt is at record highs.
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Treacherous path to election could erase memento Morrison

By Shane Wright
28 December 2018 — 12:00am
To be erased from the collective memory of ancient Rome was a punishment as terrible as death.
The destruction or reworking of statues and memorials was one way a senior Roman could have their imprint on society removed.
Sometimes it is as if the Australian government is engaged in its own form of damnatio memoriae.
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Anonymity no protection for tweeting public servants, High Court told

By Doug Dingwall
27 December 2018 — 12:00am
Anonymity gives public servants no protection from sacking for making political comments, the federal government has told the High Court.
Attorney-General Christian Porter has rejected arguments from a former Immigration Department worker, who says the government wrongly gagged her free speech by dismissing her in 2013 over anonymous anti-government tweets.
The federal government's lawyers, in a reply last week to Michaela Banerji's submissions, said the potential for public servants to be traced as the source of political comments and damage their workplace's non-partisan reputation gave reason enough for punishment.
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Coalition needs a miracle to win next federal election

The Coalition and Scott Morrison are set for an election wipe-out. These are the MPs who could lose their jobs in the looming bloodbath.
news.com.au December 28, 20187:28am
The news just keeps getting worse for Scott Morrison as new analysis shows the Coalition is failing to win back voters.
Ever since Mr Morrison took over as Prime Minister after Malcolm Turnbull was dumped, poll after poll shows voters turning away from the Liberal and National parties.
The latest Newspoll analysis prepared for The Australian and published yesterday shows the government is on track to lose 24 seats across Australia.
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The biggest porky pies: How fake news has shaped our history

By Julia Baird
29 December 2018 — 12:00am
It’s strangely appropriate that Donald Trump, the man who made popular the concept of #fakenews, this week asked a little kid if she still believed in Santa Claus. (Spoiler alert!) He then added; “Because at seven, that’s marginal, right?”
Happily, Collman Lloyd from South Carolina did not know what the word marginal meant, and politely replied, “Yes, sir.”
Collman and her siblings left out chocolate milk and sugar cookies for Santa, which vanished by morning, after Santa’s epic 24-hour cross-continental binge. You can imagine her parents rushing to clear the cookies, carefully leaving crumbs or, as I used to do, dusting icing sugar over boots to make “snowy” footprints.
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The cost of talking budget in an election lead up

By Crispin Hull
29 December 2018 — 12:00am
The first few months of 2019 will be a dangerous time economically in Australia. A Government on the ropes will be out to buy votes and an Opposition sacred of blowing it at the last minute will be almost forced to match every bribe.
And economically it is a bad time to pour money into voters’ pockets because the economy is going along reasonably well and does not need any stimulus.
A further difficulty is that any new spending in the form of tax breaks will be very difficult to reverse. Once you give voters lollies, it is very hard to take them away.
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Australian voters have every reason to be cynical

By Ebony Bennett
29 December 2018 — 12:00am
The summer period comes with many different traditions. For our family Christmas, breakfast is the main event with everyone gathering together for platters of fruit, Christmas ham, fried eggs, croissants, juice and sparkling wine and secret santa. It’s political fights with my dad. It’s trips to the beach, prawn sandwiches on the veranda as the sun sets, it’s a time for recharging your batteries and reflecting on the year that’s been before looking ahead to the year to come.
Every year, most people I know feel like they’ve just managed to scrape through until they get a break at Christmas. This year it feels like government barely scraped through.
Traditionally, I argue with my dad about politics and policy at Christmas but this year neither of us could muster the enthusiasm for a debate on anything. Politics this year is too exhausting, too stupid, too depressing. Dad, who admired Malcolm Turnbull, cannot fathom why the Liberal party knifed him in August and has now switched off politics almost entirely – he’s not alone judging by the polls since then.
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Meet the people who control your power

By Cole Latimer
28 December 2018 — 12:27pm
A blackout hits, the lights go out and everything screeches to a halt: How does the city recover?
In a bunker hidden away in a non-descript western Sydney suburb, a group of workers spring into action redirecting power to where it is needed most. The lights come back on.
This room is the nerve centre for Australia's electricity, and powers every aspect of your life.
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Where did it all go wrong for markets - and what is next?

By Tom Rees
28 December 2018 — 1:42pm
In 2018 there has been no place to hide for investors. A tumultuous year has seen bubbles burst, volatility make a long-awaited return, the record bull run face its greatest threat and trillions wiped off plunging assets.
An unnatural calm on markets has been pushed aside by worries that the economic cycle is about to turn as central banks shut off the stimulus taps and trade tensions show no sign of abating.
Copper, oil, emerging-market equities, Chinese stocks and US tech giants all entered a bear market this year - a fall of more than 20 per cent from an index's 52-week high - while 93 per cent of all assets lost value in dollar terms in 2018, a record according to Deutsche Bank.
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Labor will hit shares ‘at worst possible time’: Josh Frydenberg

  • 12:00AM December 28, 2018
Josh Frydenberg has seized on globa­l share volatility after US stocks staged a stunning recovery, warning that Labor’s $55.7 billion plan to scrap cash refunds for exces­s franking credits would hit the Australian economy at the “worst possible time”.
Bill Shorten has pledged a Labor government would stop super funds and individuals from receiving cash payments if their dividend imputation credits excee­d their total tax liabilities, warning that the refunds are unsustainable and will soon cost the budget $8bn a year.
The largest rally in US equities since 2009 — in which investors defied a rout that, just days ago, had left the S&P 500 index within a few points of a bear market — yesterday drove the biggest single-day lift in the Australian sharemarket since November 2016.
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Automated trading magnifies the madness

  • By Gregory Zuckerman and Rachael Levy
  • 12:00AM December 28, 2018
Behind the swift market slide of 2018 is an underlying new reality: roughly 85 per cent of all trading is on autopilot — controlled by machines, models, or passive investing formulas, creating an unprecedented trading herd that moves in unison and is blazingly fast.
That market has grown up during the long bull run, and hasn’t until now been seriously tested by a prolonged downturn.
Since peaking in late September, the S&P 500 index was down 19.8 per cent, before jumping 5 per cent on Boxing Day. The S&P is now down 9 per cent in December alone. It isn’t just stocks. Benchmark Brent crude oil stood above $US85 a barrel in October, and yesterday was trading near $US54.
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Election year preview: The seven issues that will decide who wins

The election is just months away and we already know how both sides will fight it. These are the issues that will decide who wins.
news.com.au December 29, 20187:46am
We have, rather mercifully, reached the end of the political year.
It started with the news of Barnaby Joyce’s affair, and finished with his fellow Nationals MP Andrew Broad embroiled in a sordid “sugar baby” scandal.
In between those rather inauspicious bookends, the Liberals knifed yet another prime minister.
But next year could be even more dramatic, with the election looming in May.
Earlier this month, Labor’s national conference and the government’s Mid-Year Economic and Fiscal Outlook (MYEFO) foreshadowed each side’s strategy.
These are the issues that will dominate the first five months of the year — and ultimately decide who wins.
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Superannuation funds’ $450m low-balance fee hit

  • 12:00AM December 29, 2018
Four million Australians are paying a total of $450 million a year in unnecessary duplicate super­annuation fees because funds are refusing to reunite inactive and low balance accounts with their owners.
Federal government legislation, first announced in the May budget but which stalled in the Senate following a fierce lobbying campaign by super funds, unions and life insurance companies, is aimed at consolidating these lost accounts so members are not paying more than one set of management fees.
Under the proposed legislation, the Australian Taxation Office would take ownership of ­inactive funds with balances below $6000 and “proactively ­reunite” people with their savings by using data-matching tech­nology.
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Cash the best asset class in 2018 as equities, commodities slumped

Updated 28 Dec 2018 — 3:48 PM, first published at 27 Dec 2018 — 11:00 PM
Investors who held on to cash and bonds have been rewarded in 2018 as global equities and commodities slumped against a backdrop of market volatility, geopolitical concerns and economic slowdown.
Despite the RBA's cash rate remaining at record low levels, cash was still a standout in a year of broad-based underperformance across the board, with the small returns offered by interest payments and term deposits outpacing other asset classes.
"I can't think of many asset classes that beat cash this year," says Perpetual's head of investment strategy Matt Sherwood.
"In 2018, global growth hit a seven-year high but global risk returns were at a seven-year low. It's been a very challenging year but cash has done very well, as it always has done in a downturn."
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The uncomfortable truth about voters' perception versus reality



Should Podiatrists Be Provided With Full Access To A Patient's #myHealthRecord?

This popped up last week:

WEBINAR - My Health Record: Revolutionising The Way We Consult

How often have you wasted time chasing clinical information about your patients or spending precious minutes in consult paper pushing? The My Health Record is here to ease your load and free up your time to focus on doing what you do best – providing exceptional patient care and delivering positive patient outcomes.
This webinar will provide you with all the information you need to gain the maximum benefit out of My Health Record to enhance shared clinical and patient centred care and integrate the My Health Record system into your business as usual daily practice.
Presentation by: Abby Raupach. Digital Health Implementation Consultant
Abby is a University qualified Accredited Practising Dietitian and has a keen interest in both community and preventative health measures. Abby’s role within the Brisbane South Public Health Network (BSPHN) is related specifically to the the My Health Record Expansion Project. Abby’s main focus as part of the My Health Record team is to build awareness and create meaningful use of the My Health Record amongst Allied Health practitioners within the Brisbane South region.
When: Wednesday 27 March, 2019
Where: Webinar (online)
Time: 7:00pm AEDT* (daylights savings is in effect so please check local times)
Cost: Free for APodA Members | $50 Non Members
Here is the link:
So this presentation by a Dietician is to help Podiatrists integrate the #myHealthRecord into their ‘business’.
In all my years of following the myHR topic never have I seen a discussion of the benefits of having podiatrists – and presumably their office staff etc. – utilising the myHR or even providing this group with access.
Do you think when people signed up for the myHR they were re-minded that the local podiatrist could access their record or that podiatrists will have the tech savvy to protect the information properly?
FWIW I reckon this is nuts and that the risk / reward ratio does not support such access.
What do others think of the allied health professions having myHR access. My view is we stick with doctors, nurses and their direct staff. The rest seems just an unvalidated grab for users who want to sticky-beak.
Such access was never contemplated in the myHR business cases AFAIK – pathetic though they were.
David.

Wednesday, January 02, 2019

Health IT Is In The Front Line To Try And Stem The Opioid Crisis in The US – Relevant Here Too!

This appeared last week:

Providers turning to health IT to combat the opioid crisis

Published December 26 2018, 7:49am EST
Providers have begun to harness technology to improve their management of opioids and avoid misuse.
It’s not a moment too soon. The Centers for Disease Control and Prevention’s most recent reports, released in November, confirm that the opioid crisis is worsening. The number of drug overdose deaths in the United states in 2017 was 9.6 percent higher than in 2016. The rate of drug overdose deaths involving natural and semisynthetic opioids like oxycodone and hydrocodone has risen steadily since 1999. The rate of drug overdose deaths involving synthetic opioids such as fentanyl, which individuals frequently turn to when they can no longer obtain prescribed opioids, increased 45 percent between 2016 and 2017.
One of the key components to reversing these trends is to keep people from becoming addicted in the first place, says Jim Turnbull, CIO of University of Utah Health and Co-chair of the College of Healthcare Information Management Executives (CHIME) Opioid Task Force. Providers are uniquely positioned to address this problem because they are the ones prescribing the drugs.
“We want to make sure we’re not contributing to addiction. We don’t want to be the source of people getting addicted,” Turnbull adds.
CHIME’s Opioid Task Force was launched in early 2018 to leverage the knowledge and expertise of its members to find and share IT-based solutions to the opioid crisis. It is compiling examples of data-driven initiatives and raising funds for its Health IT Action Center, a web-based repository for healthcare organizations seeking resources. The Task Force has also partially completed a playbook for CIOs, says Turnbull.
However, using technology to combat the crisis is still relatively new. A KLAS report on opioid management published this past September found that most provider organizations relied mainly on their EHR vendor to help them with opioid stewardship.
Some enterprising providers are taking a more hands-on approach and directly applying health IT to address opioid prescribing in their organizations. Many of these initiatives are homegrown, using an entity’s own data, and are so recent that their effects have yet to be determined. But even those projects in their infancy look promising.
“We realized we needed to see how data and IT plays into this. We’re using data as a platform to make cultural change,” says Alexander Garza, MD, chief quality officer at St. Louis based SSM Health.
Mining the EHR
Danville, Pa.-based Geisinger Health System is one of the first provider organizations to spearhead the use of data to assess its opioid prescribing habits. Pennsylvania has one of the highest death rates from opioid overdoses in the nation, according to the CDC.
“About three to four years ago, we realized that we were prescribing more opioids than we should. So we started using analytics to see how much was being prescribed and compare prescribers to others in the network,” says Geisinger’s Senior Vice President and CIO John Kravitz.
The health system created a provider dashboard linked to its EHR, using Tableau’s platform, to display the volume of opioid prescribing. The dashboard identified prescribing patterns among the providers and flagged several “heavy” prescribers. Geisinger then used the information to focus on these prescribing outliers and instill best practices in prescribing overall.
Opioid prescriptions have declined from 60,000 per month across the system to 22,000 a month, and the number continues to drop. “No one wants to be on the high end of opioid prescribing. The doctors are very aware of the numbers in the dashboard,” says Kravitz.
The dashboard was implemented in tandem with Geisinger’s redesign of its surgical program to reduce opioid use and improve the patient experience, which includes presurgical consults alerting patients to the pain levels they’ll have and the provision of alternative pain medications. That pilot program, launched in June 2017 and called ProvenRecovery, drove an 18 percent decrease in opioid usage across the organization, says Kravitz.
On November 15, Geisinger announced that the program will be rolled out across 42 surgical procedures impacting approximately 15,000 surgery cases a year, with the goal of reaching 100 surgical specialties by the end of 2019.
“We’ve started closing the spigot on getting new people addicted. It will be instrumental to have treatment programs to help [those already addicted] to help them get out of it,” says Kravitz.
SSM Health is taking a similar approach, extracting the data from its EHR and creating a heat map colored coded by diagnosis and dose to flag outlier opioid prescribers. “The heat method was used to develop a performance improvement tool. It will become part of a dashboard going forward,” says Garza. SSM is now working on how best to share the results with prescribers.
Kravitz recommends that other providers dive into this data.
“This is not rocket science. We all have the capability to produce a dashboard, pull the data and see what providers are ordering and how big a problem you have. When we saw our volume, our eyes were wide open. We had no idea,” he says.
Many more ideas are found here:
 This is really a useful summary of a range of sensible idea. Well worth a read of the full article.
David.

Tuesday, January 01, 2019

Commentators and Journalists Weigh In On The MyHR Debate And Related Matters. Lots Of Interesting Perspectives - Week 24.

Note: I have excluded (or marked out) any commentary taking significant  funding from the Agency or the Department of Health on all this to avoid what amounts to paid propaganda. (e.g. CHF, RACGP, AMA, National Rural Health Alliance etc. where they were simply putting the ADHA line – viz. that the myHR is a wonderfully useful clinical development that will save huge numbers of lives at no risk to anyone – which is plainly untrue) (This signifies probable ADHA Propaganda)
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Note: This week has just covered all the privacy compromising announcements in a week – along with the myHR. It never seems to stop!
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Making you you Establishing identity is a vital, risky and changing business

A state monopoly on people’s official identities may be weakening

Print edition | Christmas Specials

| BALTIMORE, MARSEILLE AND NEW DELHI
NEVER DITCH a party without an excuse. On a cold Sunday night in 1409, the great and the good of Renaissance Florence—men of the governing classes, painters, goldsmiths, sculptors—had gathered for dinner. Donatello was there, so was Filippo Brunelleschi, the engineer behind the great dome of the Duomo. But where was Il Grasso the woodcarver? “The fat one” had not even had the decency to send his regrets. Such a snub deserved a response.
Brunelleschi had a plan: take away his identity. “In revenge for his not coming this evening,” he said, according to Antonio Manetti’s 15th-century biography of the architect, “we’ll make him believe that he has become someone else.”
Grasso returned home from his workshop the next day to find his front door locked. He knocked, expecting his mother, only to hear a voice—Brunelleschi’s—that sounded uncannily like his own. The voice called itself Grasso and referred to him as Matteo, a local craftsman. Just then, Donatello walked by: “Good evening Matteo, are you looking for Grasso? He’s just gone inside.”
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Newcastle My Health Record Forum

When:
January 21, 2019 @ 6:30 pm – 8:30 pm
Where:
Noah's on the Beach
29 Zaara Street
Newcastle
Positive Life NSW along with KarumahHealth Consumers NSW, and the Australian Digital Health Agency (ADHA) are jointly hosting a Community Forum in Newcastle for people living with chronic health diagnoses (hep C, HIV, mental health, diabetes, disability etc) and NGO services about My Health Record (MyHR).
This is an opportunity to ask questions, get answers and work out what’s right for you. Topics will be: privacy and system security; how to use MyHR; and what MyHR means for doctors and health consumers interactions.
Note: Interesting that the ADHA is working with non-paid groups who are concerned re the myHR.
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Can Mark Zuckerberg turn around Facebook?


By Paul Smith
For a tech leader with a mission centred around creating the future, there must be a small part of Facebook chief Mark Zuckerberg that hankers for the recent past.
As 2010 ticked into 2011, the man whose company now stands accused of causing a huge variety of societal outrages, was viewed in a very different light.
Those were the days before Facebook stood accused of crimes ranging from the destruction of large parts of the free press, to the mass misappropriation of millions of users' data, proliferation of abusive content, multiple election rigging and the enablement of genocide.
Back then Zuckerberg's expressionless face stared from the cover of Time, chosen as person of the year as the world marvelled at the astonishing growth of a college dorm room creation, which had already earned the Oscar-winning Hollywood biopic treatment.
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Facebook's annus horribilis

By Paul Smith
January: Mark Zuckerberg posts a New Year's resolution to "fix" Facebook's failings.
February: 13 Russian individuals and three Russian organisations are indicted for interfering with US political and electoral processes, including the 2016 presidential election. The Facebook ads cited were seen by more than 11.4 million Americans.
February: Unilever threatens to pull its ads from Facebook if it doesn't do more to minimise toxic content.
March: United Nations investigating genocide of Rohingya Muslims in Myanmar says Facebook played a role in spreading hate speech.
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Voter tracking software changing the face of Australia's federal elections

27 Dec 2018 — 11:00 PM
As voters prepare to cast judgment in the 2018 federal election, the major parties are getting ready to study them using campaign software stacked with personal information and electorate data.
Ahead of the NSW state election in March and a likely federal poll in early May, Labor and the Coalition are refining their voter information platforms and election systems. Both sides sent staff and volunteers to the United States for the November mid-term elections as part of their efforts to roll out the latest and best technology.
Labor maintains a vast voter tracker system, known as Campaign Central, while the Coalition has attracted controversy for its use of the Feedback platform, operated by its privately owned-company, Parakeelia.
Liberal MPs each pay about $2500 to use Parakeelia's software, funds sourced from taxpayer-funded electorate allowances.
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Want to build an independent campaign? First step: find 50 supporters

By Max Koslowski
28 December 2018 — 11:45pm
After announcing she would contest Wentworth, a seat so blue ribbon that it has been held by the Liberal Party or its conservative predecessors since Federation, Kerryn Phelps did not know where to start.
"It was unfamiliar territory,” she said. "We didn’t have any kind of campaign infrastructure, we didn’t have a list of volunteers, we didn’t know whether we would be able to raise the funding that we needed. We didn’t even know what kind of budget we would need to run the campaign.
“We were a pop-up campaign - and the reason that I say that was that we really literally did pop-up from nothing.”
Two-term Indi independent Cathy McGowan knew Dr Phelps would be struggling in Wentworth. Ms McGowan called up to offer help from her Indigo Valley farm, 600 kilometres away in Victoria, and was soon on a plane to Sydney. Centre Alliance’s Rebekha Sharkie - who has won an election in Mayo twice in the past three years - had done the same, and when she arrived she shared advice and helped Dr Phelps through an early press conference.
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Nova warns listeners of data breach affecting 250,000 Australians

By Jennifer Duke
28 December 2018 — 4:50pm
Lachlan Murdoch’s Nova Entertainment has warned more than 250,000 listeners that data collected about them between 2009 and 2011 has been publicly disclosed, including residential addresses and birth dates.
Nova chief executive Cathy O’Connor said in a statement on Thursday that individuals were being notified about the steps they can take, with the disclosed information varying from person to person.
 “We are taking all necessary measures to ensure the strength and effectiveness of our cyber security, and there is currently no evidence of any suspicious activity or threats on Nova Entertainment's systems,” Ms O’Connor said.
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Nova Entertainment admits to publicly disclosing listener information

  • AAP
  • 2:26PM December 28, 2018
Australian media company Nova Entertainment says information it collected from listeners over a two-year period has been “publicly disclosed”. The company says it recently became aware listener information from May 2009 to October 2011 has been leaked and it is in the process of contacting those affected.
“We have notified the Office of the Australian Information Commissioner of this incident, and we are in the process of contacting law enforcement bodies,” CEO Cathy O’Connor said in a statement.
“We will fully and transparently engage with these entities in relation to this incident.” The information disclosed may include names, gender, dates of birth, addresses, emails and phone numbers and user account details such as user names and passwords, which are protected by a security technique, known as ‘hashing’. While passwords are not visible in plain text, there is a risk they can be decrypted, potentially allowing others to gain unauthorised access to online accounts.
Note: As one expert asked – just what was Nova holding personal data from 2009-2011 for. An outrage and violates all sorts of principles and laws I believe.
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Open banking: Consumer data rights a double-edged sword for financial sector

Updated 21 Dec 2018 — 5:14 PM, first published at 20 Dec 2018 — 11:00 PM
Warning: the banking sector is entering a consumer data minefield.
After a year of unprecedented scrutiny by the Hayne inquiry, banks are desperate to ensure the sharing of customer data under the government's "open banking" regime doesn't sow the seeds of the next royal commission.
Hailed by the government as a landmark policy to facilitate competition, its proposed "consumer data right" is a double-edged sword for both banks and their customers.
For banks, using data to ascertain the true financial position of a customer has many benefits. It could help them respond to the Hayne inquiry, which is expected to recommend lending requires more than just estimating income and expenses. Real transaction data can provide the decisive picture.
But there are also dangers. Community expectations on the use of data are amorphous and still developing. And data sharing creates new security and privacy risks, which will be tough for banks to manage.
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Medibank boss diagnoses issues

  • 12:00AM December 24, 2018
In his CEO Survey, John Durie asked more than 60 of the biggest names in business five key questions about what’s coming in 2019. Here’s what Medibank’s chief executive Craig Drummond had to say:
What should be the key issues in the next federal election campaign?
All political parties should be focused on ensuring a strong economy and delivering higher real wage and jobs growth. Australia has done well over the past quarter century or so and the country needs to look in a mature and considered way at the reforms necessary to ensure our standard of living continues to rise.
What use are you making of customer and company data and how are you collecting it?
Using analytics and predicative modelling of claims, administrative and publicly available data, Medibank is able to better predict customers with the highest risk of hospitalisation in the next 12 months. Insights enable us to identify Medibank customers who will benefit most from our chronic disease programs, supporting people in managing their own wellbeing and reducing the risk of hospital attendance or admission.
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My Health Record – what you need to know

My Health Record promises better coordinated health care for all Australians – but what about privacy and security concerns?

Stay in or opt out?


  • By the early 2019, electronic health records will be set up for every Australian, including children
  • They can be accessed by you, your doctor and other healthcare professionals
  • You can opt out until 31 January 2019
  • Six million Australians already have a record – some without their knowledge
  • Health care experts welcome the new centralised record, but security experts warn of data breaches that can expose sensitive data
By the end of 2018, the federal government will have set up an electronic health record for all your health data – including sensitive issues like mental health treatments and other conditions you may wish to remain private – unless you opt out by 31 January 2019.
Doctors will be able to access your record to assist in their treatment of you, which could be essential in emergency situations. But security experts warn privacy breaches are only a matter of time.
There's been a lot of public discussion since the three month opt-out period started last week. So we've looked into the pros and cons to help you decide if you want in or out.
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Facebook can't fake it any longer

21 Dec 2018 — 11:00 PM
The photograph is horrific. An Indian man in a blood-soaked shirt is standing on a road. Dangling from his hand is a severed head, dripping blood. Staring out from the familiar white and blue frame of a Facebook news feed, the photo's caption says the image is of a Hindu man who beheaded a Muslim politician for raping his sister. It then asks provocatively: "Does the Hindu deserve punishment?"
But something isn't right. The photo is real but the story behind it is completely false, made up in an apparent attempt to stoke religious tensions in a country where such provocations can quickly lead to violence.
In a busy New Delhi newsroom, on the third floor of a weather worn building in the Indian capital's business district, Facebook's fight against lies kicks into gear. Having been flagged by a fact checker freshly hired by Agence France Presse, the photo is put through a reverse image search. Taken six weeks earlier, it actually shows a Hindu man turning himself in to police after murdering another Hindu, who had insulted his mother. Religion had nothing to do with it.
The fact-check is done by Australian journalist Karl Malakunas and his team at Agence France Presse, which has been hired by Facebook. In this instance they limit the damage. The post, which has already been shared hundreds of times across different Facebook groups, including one called "War Against Paid Media", is labelled 'false'.
At this point Facebook intervenes. When a post is confirmed as 'false' the social media giant removes it or dramatically reduces its distribution in an effort to stop it going viral – something that can happen very quickly in India, where the number of active Facebook users is heading toward 300 million, the most of any country. If it is not removed, Facebook adds a pop-up alert so that users who still find the post are prompted to read the fact-checker's report explaining why the claim is wrong.
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How to prevent specific health information being uploaded to My Health Record

Note:
A participating provider is authorised by law to upload health information about an individual to their My Health Record, unless the individual withdraws their consent or the information relates to a prescribed State or Territory law.
To prevent Shared Health Summaries or Event Summaries being uploaded
1. If your patient requests that no Shared Health Summaries or Event Summaries be uploaded to My Health Record by your practice, go to the Consent section (e.g. via patient demographic section).
Tick Consent for My Health Record indicate how the consent was provided, tick Refused and click Save.
Once consent has been refused withdrawn MMEx will not allow access to My Health Record by users from the organisation.
 Read about MMEx here:
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WEBINAR - My Health Record: Revolutionising The Way We Consult

How often have you wasted time chasing clinical information about your patients or spending precious minutes in consult paper pushing? The My Health Record is here to ease your load and free up your time to focus on doing what you do best – providing exceptional patient care and delivering positive patient outcomes.
This webinar will provide you with all the information you need to gain the maximum benefit out of My Health Record to enhance shared clinical and patient centred care and integrate the My Health Record system into your business as usual daily practice.
Presentation by: Abby Raupach. Digital Health Implementation Consultant
Abby is a University qualified Accredited Practising Dietitian and has a keen interest in both community and preventative health measures. Abby’s role within the Brisbane South Public Health Network (BSPHN) is related specifically to the the My Health Record Expansion Project. Abby’s main focus as part of the My Health Record team is to build awareness and create meaningful use of the My Health Record amongst Allied Health practitioners within the Brisbane South region.
When: Wednesday 27 March, 2019
Where: Webinar (online)
Time: 7:00pm AEDT* (daylights savings is in effect so please check local times)
Cost: Free for APodA Members | $50 Non Members
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Australia made third highest number of requests for Apple data in the world

In the first half of 2018 Australian authorities made 2,375 requests, more than China, Singapore or the UK
Apple received 2,357 “device requests” from the Australian government and law enforcement in the first half of 2018, the third-highest rate of requests in the world.
The tech company published its twice-yearly transparency report on Friday, which reveals how many times governments asked Apple for data and information about iPhone, iPads, computers and Apple accounts.
Requests can be made for a range of reasons – from helping to find a lost phone, to investigating iTunes gift card fraud. They include subpoenas, court orders, warrants and wiretap orders.
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Apple reveals scale of government requests for users' data

By Laurence Dodds & Olivia Feld
24 December 2018 — 10:01am
National governments demanded access to 163,823 Apple devices in the first half of 2018, according to figures released by the company.
The latest Apple transparency report showed that it received 32,342 requests to access the contents of iPhones, iPads and other gadgets, a 9 per cent increase from the second half of 2017.
The tech giant, which granted 80 per cent of requests worldwide, disclosed the number of devices from which data was provided to governments.
The UK made 572 requests, of which 77 per cent were deemed legitimate, while the biggest applicant was Germany, with 13,704, and the United States, with 4570. Apple did not disclose which government agencies made requests.
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Comments welcome!
David.