MUST READ: A Health Warning For Liberals

Medicine is pressured by a radical socialist transformation

Medicine is pressured by a radical socialist transformation. Some of this is top down. Much of it is bottom up, writes Dr Grant N Ross

For
2 years I was the Melbourne University Liberal Club’s token doctor.
Turning up late, or never, I would always be out of kilter with JSM,
political theories and fights of the day and somewhat under the
impression that Kroger was a kind of cheese. 
Luckily,
being a stereotype got me over the line.

I
would like to redeem my standing by attempting to write about the
direction of health under Labor and the alternative policy direction
the Liberal Party should choose when in Government.

I
feel that there is a need f
or a Liberal establishment to take note of
the direction of health under Roxon and Plibersek and to hear the
story I am about to tell about the pressures within medicine that
will come to change the way doctors do politics for the next 20
years. All is not well, and I want to tell you why.

As
we speak, Medicine is pressured by a radical socialist
transformation. 
Some
of this is top down. Much of it is bottom up.

The Top Down 

 From
the top down, there have been a series of reforms that:


  • Create
    a greater role for government in health


  • Are
    mostly anti-doctor


  • Occurred
    without significant consultation with the medical profession


  • Involved
    the creation of enormous layers of bureaucracy to centrally manage
    an existing private industry


  • Prioritised
    special interests and unions rather than the front line service
    deliveries

Such
reforms include the creation of many different councils to
micromanage various health care aims instead of directly funding
practitioners; and by doing so orchestrate a transfer of power away
from practitioners and patients towards bureaucrats and their
interests.

A
quick list of the agencies and bureaucracies created by federal Labor
include the following:

  • Australian
    commission on safety and quality of healthcare

  • National
    Health performance authority

  • Independent
    Hospital Pricing Authority

  • The
    Administrator and funding body

  • Medicare
    Locals

  • Australian
    Medical Locals Network

  • Australian
    national preventative health agency

  • Local
    Hospital Networks

  • Health
    Workforce Australia

  • Aged
    Care Reform Implementation Council

  • Mental
    Health Commission

  • Aged
    Care Financing Authority

There
are three cardinal reforms by Labor that have made things worse in
health; national registration, Prescribing and Medicare Locals.

National
Registration

Since
2010 we have had the imposition of a massive tax on doctors by way of
a National Registration reform by Nicola Roxon.
Previously, doctors were registered to a state body but are now
registered to the Australian Health Practitioners Registration
Agency; a centralised national authority.

AHPRA,
formed by Labor to ‘facilitate’ national registration, imposes a
$680 ‘Doctor Tax’ on doctors every year; much higher than
previously imposed. The agency’s role, it seems, is to run a police
check once a year, keep names on a register and then deal with a
doctor if they do something wrong by threatening or taking away the
legal right to practice Medicine.

Whilst
most doctors agree on the need for professional regulation, nobody
accepted the AHPRA model being imposed in the face of a functioning
previous system.

There
is an overwhelming sentiment among the medical community that the
AHPRA reforms are decidedly anti-doctor. Firstly, they removed
semi-autonomy from the previous state based QUANGOs. Secondly, the
AHPRA came about against the wishes of the AMA and the medical
profession at large. Thirdly, doctors have to pay extraordinarily
higher registration fees. Fourthly, AHPRA lumps doctors together with
other health professionals in an overt breach of professional
autonomy:


Ahpra

Footnote I – The Health Practitioner Regulation National Law came into effect in 2010. Whilst it was a COAG agreement, AHPRA was a cornerstone commitment of Labor and driven largely by their political agenda and under mostly government influence.

What
is most worrying is that the registration reforms are a direct step
towards the complete Federal take over of health; via monopolising
the licensing of ALL health professionals in the country to one
federally controlled agency. This should be interpreted as a step
towards government socialisation of the entire health workforce. 

Nobody
is quite sure what will happen in the future with AHPRA. I would look
at it as a dysfunctional way of registering doctors and a target for
reform under a Liberal government.

Prescribing
under Labor

The
Labor reforms have particularly offended the medical profession by
allowing nurses and other non-doctors to prescribe medications.
Prescribing has long been the privilege of the physician, a deeply
difficult and precise business and the Government have legislated for
non doctors to prescribe dangerous medications.

Doctors
still do not agree with this. Below is an example of a lethal
medication that should not be given to people in a range of
circumstances ranging from addiction to intra cranial conditions that
is available from a nurse with no medical training. 

DHA

Footnote II – http://www.ahpra.gov.au accessed 6/11/2012
  
Whilst
nobody would wish the loss of political capital by enabling more
practitioners to prescribe, a government should make a principled
stand on prescribing and give that right exclusivity to those who
lead the health system; doctors. Put simply, do not politicize
opiates; morphine is a drug, not an entitlement. We are all better
off without this gray zone.

General
Practice and the Medicare Locals

Medicare
Locals are essentially the creation of large bureaucracies all across
Australia to control the delivery of General Practice services.
Marking the greatest shift of power away from the functioning private
sector to yet more bureaucrats, these organizations claim to
‘coordinate resources’, ‘identify gaps in access’ and other
nebulous imperatives.

They
are really about creating a centralized bureaucracy, more removed
from front line services, to control the allocation of General
Practice visits. Most of these agencies will be run by non-doctors
with political agendas. This
WILL
redirect front line funding.

Whilst
most left leaning elitists and pundits would label a move against
Medicare Locals as ‘protectionism’ for doctors, it should be a
Liberal priority for several reasons.

Fee
for service, rather than centralized allocation, is the most
efficient form of funding for primary care. Doctors alone deliver the
vast majority of primary care via their minute to minute labor.
Direct funding is clearly superior.

Secondly,
reinforcing private practice builds trust within the medical
profession and empowers doctors to deliver good care for their
patients.

Thirdly,
it builds on the only model that can safely deliver cost effective
health care in a flexible and dynamic way. There is pragmatism within
the medical profession that is unrivaled in history. Pragmatism
requires individual liberty. It is the antithesis of bureaucracy.

Doctors
should be allowed to govern how they arrange their practice and the
market is the best way to ensure that each patient finds the doctor
they prefer. We all know that we would prefer to choose our doctor
when we need them; not when the government tells us.

I
have written about three big players in the health reform agenda of
the last 5 years. National Registration and the step towards
socialist health system, widening of prescribing rights and finally
the complete government takeover of General Practice. These are just
a few example of the top down socialist pressures on health that I
have noticed. 
Alas,
they are not the most worrying change ahead of us.

Luckily
for us, Peter Dutton, Shadow Minister for Health, has already
demonstrated his capacity for reform by pledging to scrap the
Medicare Locals and GP super clinics.

Dutton
is an ex policemen, successful businessman, ex-Minister in the Howard
Government and assistant treasurer to the great Peter Costello. He is
clearly a man who understands health and has a distinct policy vision
to restore the health system to a position of strength, rather than
interference and bureaucratization. I believe he will be warmly
welcomed by the medical community and be one of the best advocates
for the restoration of a sensible health system.

The Bottom Up 

Dutton

I
have spoken about some of the top down pressures in a socialist
direction on the health system. I would like to talk briefly about
some of the pressures from the bottom up, that only a doctor can see,
that are still pertinent to the Liberal agenda.

If
the fantasia reforms of the Roxon/Plibersek era are anything to lose
sleep over, they are nothing on the bottom up forces plaguing
medicine at a much more sinister level.

Since
my entry into medicine as a first year student in 2006, the values
underpinning medicine have been rampantly veering towards the left.
The pressures mounting from the bottom, aka medical school
environments, are horrendously aligned with ALP and Greens stigmata.
For those who thought that foaming at the mouth socialism and
bureaucratic elitism were limited to the confines of the Arts
departments, you are wrong.

The
Medical schools themselves have pursued a long march style reform
into the medical degree; especially in the selection of candidates.
Traditionally, school leavers were selected based on ENTER/ATAR score
and the Undergraduate Medical Admissions Tests. No test is perfect,
but the principle was that admission was based on objective academic
capacity; with a view to selecting bright school leavers (whether
advantaged or otherwise).

This
principle cemented medicine as being about academic capacity,
something worth its salt in any market, rather than ‘social
equity’. This is the right way for things to be.

Nowadays,
courses almost universally select via interview. You can dress up how
‘official’ and ‘standardized’ your interviews are, but they
remain the quintessence of subjective selection. That is the purpose
of interviews. They are effectively a mechanism to allow people to
form a personal opinion on a candidate. And exercise bias. 

Adelaideu

On
a background of the inherent socialist tendencies of education at
both secondary and tertiary level, the reforms to selection have
outright enabled the medical schools to pursue a political agenda
that aims to expand the role of government in healthcare, involve
medicine into a nexus of government social equality agendas and
further the promotion of minority special interests to any particular
degree. This is the definition of long-marching.


Wollong

The
results of these efforts are now coming to fruition. Medicine is
becoming overtaken by special interest group after special interest
group, all vying to dictate the rules of medical practice and
employment, values and principles in an ever growing mountain of
elitist control. The effects of this can be seen via organizations
such as the Australian Medical Students Association, the Post
Graduate Medical Council of Victoria and even the Medical Journal of
Australia and the Australian Medical Association; a nexus of
bureaucratic woe:

Amsa

Footnote III – http://www.amsa.org.au

These
organizations are replete with bureaucratic choke holds and
indecisive post modern ‘collaboration tactics. The result,
obviously, is what we have seen under Kevin Rudd: Power from the
people to their overlords in an ever growing unholy alliance of
bureaucrats, red tape and pathetic backyard politicians who would
rather do anything to promote themselves rather than a good idea. It
promotes ‘sellout politics’ and betrays the individuals who
together make medicine what it is and what gives individuals the
right to be free in this country. 
So
long as this framework persists, doctors will be worse off and
patients will be worse off. 

 At
the moment, the AMA can be proud of the leadership it has had.
Brendan Nelson went on to become Liberal Party Leader. Rosanna
Capolingua was clearly Liberal, Michael Wooldridge kept General
Practice sustainable and independent. Steve Hambleton, current AMA
leader, stands for sensible restraint and genuinely aims to protect
autonomy for doctors. We have been lucky. But I am not so sure about
our future. Just look at what the ever growing Australian Medical
Association calls for on Climate Change:

Amsa2

Footnote IV – http://www.amsa.org.au/press-release/20120703-amsa-calls-for-leadership-on-climate-change/
  • Australian
    Medical Student Association


    Health-climate-change

    Footnote V – Australian Medical Students 2010 Policy Document Climate Change and Health see website http://www.amsa.org.au
  • The
    Australian Medical Association’s is little better than the student
    body in this regard:
     
Ama

Footnote VI – http://ama.com.au/node/4442

I
think I have made my case. 
If
anybody in the Coalition did have a silver bullet to stop the long
march, they’d immediately be preselected for a golden safe seat. I
am not that man.

However,
if we were to theoretically look at reversing the political bias
pressuring medicine in Australia, I would start with reforms that
target medical selection, medical training, the de-bureaucratisation
of medical registration at the junior level and aim to move the
governance of medical training away from University bureaucrats and
elitist back to grassroots doctor groups.

This
would help. 
There
is an argument for such change on the basis that it restores
efficiency and principles of autonomy to the medical profession and
by extension of that, to patients. It would be one hell of an effort,
but I honestly do not believe it to be beyond an Abbott government to
achieve in some capacity.

The
other issues are perennial for Liberals; especially for those of us
who have campaigned on campus. The fight against bureaucrats, against
elitists and to genuinely reform education in this country in the way
that David Cameron is trying in England. Perhaps some of the above
changes could be caught up in a commission of audit. I would like to
see that. But I don’t know. I am not a politician.

Conclusion

As
a doctor, I naturally bring more of a background of social sciences
and welfare to the Liberal table than I do tax reform and economics.

However, there is a need for a Liberal establishment to take note of
the direction of health reform that the Roxon and Plibersek ministry
has imposed on health and a need to identify them as inefficient,
retrograde, centralist and to be removed as needed. Equally important
is the message I would like to impart about the need to think about
what is needed to prevent the medical establishment being long
marched into foot soldiers for the ALP.

Just
remember, health accounts for 12-17% of spending and employs 11% of
all Australians. That is one hell of a voter base to lose to the
left.

Peter
Dutton has a lot to contribute to health in the next Liberal
Government. Autonomy, efficiency and restraint will serve our country
well. Similarly, I encourage young Liberals in rising positions of
leadership to consider the principles of a sound health system as
they develop their policy directions.

The electorate expect a good
health system and we have no excuse for leaving ourselves weak on
this front from a simple lack of knowledge.

Dr
Grant N Ross MBBS B.Med Sci is a medical practitioner and graduate of
Melbourne University.

 

Footnotes

Footnote
I – The Health Practitioner Regulation National Law came into effect
in 2010. Whilst it was a COAG agreement, AHPRA was a cornerstone
commitment of Labor and driven largely by their political agenda and
under mostly government influence.

Footnote
II –
http://www.ahpra.gov.au/
accessed
6/11/2012

Footnote
III –
http://www.amsa.org.au/
see About AMSA accessed 6/11/2012

Footnote
IV –
http://www.amsa.org.au/press-release/20120703-amsa-calls-for-leadership-on-climate-change/

Footnote
V – Australian Medical Students 2010 Policy Document Climate Change
and Health see website
www.amsa.org.au

Footnote
VI –
http://ama.com.au/node/4442


Excessive consumption and its challenges for centre-right values

Terry-Barnes

Terry Barnes discusses the quality of spending in our economy.

In January I wrote an article in The Age about the social challenges of debt-funded household consumption – mortgages, credit cards and what we buy with them.  I was prompted by a trilogy of statistics that came out over the holiday period – Australians’ household debt now exceeds our Gross Domestic Product; our average new house size is now the largest in the world; and retail spending for last November was four times the trend.

Basically, I argued that as a society perhaps we are spending like Othello loved: “not wisely but too well”, and that public policy might have a role in helping to constrain excessive consumption.  I suggested, mischievously and deliberately provocatively, imposing a space charge on large houses calculated on the number of residents, which was really (as several economists noted) a take on the Windows Tax of centuries ago, and a GST surcharge on luxury items. The aim was at least to make people think twice about their purchasing habits.

The range and passion of many of the comments on the article took me by surprise.  At one end my libertarian friends were concerned for my sanity and pointed out that inherently individuals always know best how to spend their own money.  At the other some communitarians and socialists felt I didn’t go far enough on the grounds that all property is theft.

But most responses were somewhere in the middle.  The general view was that my suggestions were perhaps misguided and a tad heavy-handed but yes, excessive consumption and the temptation on people to spend money they don’t have on things they don’t always need are real social concerns.  I was also told first-hand stories of the consequences of unaffordable household debt that were poignant and tragic.

I still believe strongly in capitalist society and the free market as the best mechanism to guarantee individual and community prosperity  – although painfully for me I was lumped together by some with arch-Green Clive “Affluenza” Hamilton.  Governments shouldn’t intervene in private affairs unless absolutely necessary and, as the Institute of Public Affairs’s Julie Novak rightly pointed out, any policy solution involving taxes or charges is simply diverting your money into the hands of the people least qualified to spend it wisely – the government.

The best answer by far, as economist Ian Harper and others have observed, is what Harper calls “the gift of self-control”.  All of us have the power to restrain our own impulses to buy more than we need or can afford.  As few of us have the ability to afford everything we want, that’s something most of us have to do.  What’s more, many of us find it a big struggle to resist the urge to splurge – and I’m certainly no paragon in that regard, as my groaning bookshelves and rarely listened to CDs attest.

Nevertheless, I genuinely am troubled by the paradox that while the market thrives on our demands as consumers of goods and services (including housing), it is blind to the quality of that demand.  Indeed, it’s actually in the market’s generic interests not to ask questions about the quality of the spending.  If you are spending on goods and services, thus creating more jobs and wealth, the market isn’t going to stop and ask you if you’re really sure you can afford it.  It wants you to keep spending as much as you can.

How do we of the Centre-Right address this market paradox and its consequences for those who run into trouble?  Even after the comments on my article, and reading more widely since, I’m not really sure.  

What I do know is that, in a world with an ever-growing population and finite natural resources being a conservative or libertarian is more than promoting personal freedom and reward for effort.  It’s also about how best we live our lives in a world with an ever-growing population and finite natural resources – including the land on which we build our houses and which produces what we need to run them.  In this sense the gift of self-control, of being thrifty and living within our means, is a positive value that we on the centre-right can all strive for, and can help others if they’re struggling with it.

Until a few decades ago, our culture valued and rewarded prudence and thrift, as anyone then saving for a home loan deposit could tell you.  Those days appear to be gone.  How we bring them back, while balancing the needs of thriving consumer and housing markets with fostering the gift of individual self-control, will be a worthy challenge for the next generation of centre-right Australian governments.

Terry Barnes is an editor of Menzies House.