WikiLeaks: Cuba banned Sicko for depicting ‘mythical’ healthcare system

More WikiLeaks revelations to embarrass the left. Today, the Guardian reports the following: 

Cuba banned Michael Moore's 2007 documentary, Sicko, because it painted such a "mythically" favourable picture of Cuba's healthcare system that the authorities feared it could lead to a "popular backlash", according to US diplomats in Havana.

The revelation, contained in a confidential US embassy cable released by WikiLeaks , is surprising, given that the film attempted to discredit the US healthcare system by highlighting what it claimed was the excellence of the Cuban system.

But the memo reveals that when the film was shown to a group of Cuban doctors, some became so "disturbed at the blatant misrepresentation of healthcare in Cuba that they left the room".

Castro's government apparently went on to ban the film because, the leaked cable claims, it "knows the film is a myth and does not want to risk a popular backlash by showing to Cubans facilities that are clearly not available to the vast majority of them."

You know, the more and more I'm reading WikiLeaks stories, the more I'm starting to like them!  

UPDATE: Michael Moore disputes this

(Posted by TVA. h/t Reason)

Australia’s Health Policy: The vortex of Doom

Tim-Humphries

Tim Humphries writes in support of a private solution for our ailing health system.

I remember vividly during my Teenage years playing a computer game called Doom. The first person shooter game pitted you against monsters of grotesque form and required you to dispose of them with various weapons.

You might think that talking about an old cgi computer game would be disconnected from a discussion about this country’s health policy. However to me the nihilistic nature of Doom and this countries health policy seem inextricably linked.

I have been following very carefully recently, the Dr Jayant Patel case and have been struck by the way that the media have reported it.

A man died at the hands of Dr Patel three weeks after the former surgeon allegedly removed part of his bowel and failed to pinpoint the source of bleeding, a court has heard.

Crown Prosecutor Ross Martin QC described in detail to the Brisbane Supreme Court the manner in which 75-year-old pensioner Mervyn Morris was allegedly treated at Bundaberg Hospital in 2003.

Dr Jayant Patel, was charged with 3 separate counts of manslaughter during his tenure as Director of Surgical Services at the Bundaberg Hospital from 2003-2005.

Dr Patel was also charged with grievous bodily harm in relation to the case of Ian Vowles. Dr Patel pleaded not guilty to all charges and the trial has been on-going.

Despite the fact that Dr Patel is alleged to have executed several procedures that were exploratory in nature including colonoscopy, it has been alleged that the bleed point was not successfully traced.

Having not discovered any internal bleeding, Dr Patel allegedly independently decided to remove a section of the man’s bowel and subsequently installed a colostomy bag.

After several complaints from the family about lack of appetite and difficulty breathing, the patient continued to deteriorate and died on June 14 2003.

It was heard that Dr Patel assured the Morris family through his daughter that the patient would get better.

It was alleged by the prosecution that Dr Patel’s treatment of the patient was directly connected to his “avoidable death”.

The case is ongoing and conjures in my mind a very specific symptom of health policy failure in this country that extends to both sides of politics.

The internal cynic in me seems to have come to the conclusion that Prime Minister Kevin Rudd deliberately wants to ignore real health reform, as demonstrated by his recent forays into the re-assignment and re-branding of health funding arrangements at COAG.

To move piles of money around the room and proclaim that the movement of aforesaid piles of money is actually going to achieve anything is naive and verging on irresponsible.

The truth is that this country needs a significant overhaul of the way that its Health system is operated.

As centre-right thinkers, we need to pay close attention to policy options in future that will increase the capacity of health services in this country by moving to a user pays system that is accessible to more of our fellow Australians.

I believe that we have failed consistently in relation to private health policy, thus discouraging the entry of more private providers into a true market space that would inevitably drive down costs, provide better outcomes and avoid the Vortex of Doom that I have previously alluded to.

If Australia’s future population projections are going to be realized its time to stop playing bureaucratic games with buckets of money and begin the serious process of shifting the paradigm of state v.s. private health to a new level of thinking.

Both state and private health systems are important. Fiddling with tax excise increases as has been proposed by previous Leader’s is pithy in its magnitude and will do nothing to break the strangle hold that Government currently exerts on Health care in this country.

Ronald Reagan said it best when he stated the following:

Now in our country under our free enterprise system we have seen medicine reach the greatest heights that it has in any country in the world. Today, the relationship between patient and doctor in this country is something to be envied any place. The privacy, the care that is given to a person, the right to chose a doctor, the right to go from one doctor to the other.

But let’s also look from the other side, at the freedom the doctor loses. A doctor would be reluctant to say this. Well, like you, I am only a patient, so I can say it in his behalf. The doctor begins to lose freedoms; it’s like telling a lie, and one leads to another. First you decide that the doctor can have so many patients. They are equally divided among the various doctors by the government. But then the doctors aren’t equally divided geographically, so a doctor decides he wants to practice in one town and the government has to say to him you can’t live in that town, they already have enough doctors. You have to go some place else. And from here it is only a short step to dictating where he will go.

This is a freedom that I wonder whether any of us have the right to take from any human being. All of us can see what happens once you establish the precedent that the government can determine a man’s working place and his working methods, determine his employment. From here it is a short step to all the rest of socialism, to determining his pay and pretty soon your children won’t decide when they’re in school where they will go or what they will do for a living. They will wait for the government to tell them where they will go to work and what they will do.

The real Health revolution will come from a recognition that Australia must at some stage in the future move to a user pays system that introduces market forces that will boost supply and drive down costs for the consumer. 

In the end avoiding the vortex of doom requires Government to get out of the way, without this state intervention is all we can look forward to in the future.

Tim Humphries is a Brisbane based Independent Contractor and blogs at http://mothypress.wordpress.com/

Rudd Takes an Election Gamble

Andrew-Lewis Rudd’s hospital gamble has made this election year a whole lot more interesting, writes Andrew Lewis.

Kevin Rudd recently announced a major reform to the way public hospitals are funded, in an attempt to fulfil his election promise that if the states continued to underperform in the administration of public hospitals, then he would take over the public hospital system.
Rudd needs the states to cede control over public hospitals, because under the Constitution of Australia, states retain control of hospitals. Mr Rudd will move this reform at the April 11 COAG meeting, in the hope that the State Premiers will agree to his request.

If they don’t, Rudd has stated that the Government will take the funding takeover of public hospitals to the people at a referendum. This would likely take place alongside the Federal Election later this year, to save on costs and prevent election fatigue.

The task in front of the Rudd Government is a tall one. Currently two of the six State Premiers are suggesting they will not agree to this power grab. With good reason too, as any move to remove responsibility for public hospital funding from the states would be the beginning of the end for state government and Australian Federalism.

If Mr Rudd wanted to lean on his ALP buddies in the states, that may be less likely by April 11. With already one ALP Premier telling Rudd to nick off (Victorian Premier John Brumby), he needs friends, but with two ALP Premiers facing tough elections before the end of March (David Bartlett in Tasmania and Mike Rann in South Australia), he may see fewer friendly faces in April than he has seen previously.

If the COAG meeting does not provide Rudd with the results he seeks, then it’s off to the polls – a referendum to alter the Constitution of Australia so the Federal Government would have responsibility for funding public hospitals.

This could be even more problematic for Rudd than convincing the six State Premiers. As a rule, referenda in Australia fail, with only 8 out of 44 succeeding in 109 years of Federation. This is in part due to referenda needing an overall majority of voters voting in the affirmative, as well as a majority of voters in a majority of states.

Further to that, no referendum has ever succeeded in Australia without having the support of the two main political parties of the time. With the Coalition opposing the federal takeover, you can see that any referendum on public hospitals would have to make Australian electoral history in just succeeding.

Now, if Rudd held the referendum at the same time as a Federal Election in order to save money, then he takes on an added risk of both votes becoming referenda on his leadership. It would be a groundbreaking situation; a referendum on a key area of government policy being held at the same time as a Federal Election. Previous referenda held concurrently with Federal Elections have generally been related to areas of electoral housekeeping.

Three things can occur if Rudd holds an election and a referendum at the same time, as there is no chance that Rudd loses the election but wins the referendum.

Firstly, Rudd could win both the election and the referendum. Mr Rudd comes out with a stronger mandate than any Prime Minister in living memory, a ringing endorsement of his leadership, and a separate endorsement of a key election platform.

Secondly, Rudd could win the election but lose the referendum. This seems the most likely given Australian electoral history (Australia does not have one term federal governments, or pass referenda without bipartisan support). This would leave Mr Rudd as an impotent Prime Minister, without a mandate to implement policy in a vital area of government administration. It wouldn’t be long before Rudd was replaced with Julia Gillard, and the government moved on without implementing its plan for funding public hospitals.

Finally, Rudd could lose both the election and the referendum. The real kick in the guts would be that the defeat of the referendum would probably be a major contributory factor in his losing the election, and he would break new ground in leading the first one-term Australian federal government since the great depression.

It’s a massive risk for Rudd to take, and it’s hard to see why he is taking it. Despite the Coalition’s improved showing in the polls, the Rudd Government is still most likely to be returned. He’s staking his political career on either the states commencing their own demise by signing away their most important area of responsibility, or the Australian public doing something it hasn’t done in 109 years: endorsing a change to the Constitution of Australia without the support of both the Government and the Opposition.

The 2010 election year just became a lot more interesting.

Andrew is a Melbourne writer, and writes on politics and sport. He is a featured writer on the AFL site www.bigfooty.com, and also has his own blog, which can be found here.

Our 6.3 GP visits per year are more likely to be the result of a sick health system, rather than Australians becoming sicker

Monique-Beguely We aren't necessarily getting sicker, despite the statistics, writes Monique Beguely.


News that Australians are becoming sicker than ever with an average of 6.3 GP consultations per annum, the highest in the Commonwealth, is more likely to be a result of systemic problems within Australia’s health system – not because Australians are becoming sicker than ever, as the new reports are claiming. 

 
Consider some of the following facts that could contribute to this allegedly higher number of GP visits:

  1. The Medicare system itself.  My lawyer charges $440 per hour, my accountant is not far behind him!  I can visit my GP for $60 and the government/Medicare will refund me $32.80.  My out of pocket expense for this visit is $27.20.  If I should become eligible for the Safety Net at any stage during the year, I will receive an additional refund of $21.75.  The cost of my GP visit will be reduced to $5.45 per consult for the rest of the year, regardless of my level of income.  I am going to seriously debate with myself whether I really do need to visit my lawyer or my accountant, I am not going to think twice about whether or not I need to see my GP.  I think that the Medicare system leads Australian’s to devalue the services that GP’s provide, and in some cases leads to abuse of this system (by both patients, and in some cases by the GP’s themselves – I will come back to this point later).
  2. Due to the laws governing issues of privacy and confidentiality GP’s no longer provide test results over the telephone, as they previously did.  The patient is required to make an additional appointment to find out their test results. 
  3. Most GP’s no longer write out a repeat script for their patients to pick up at reception, as they routinely did in the past.  They now require you to make an appointment for something as simple as a script, and then bill a Medicare consult accordingly.  In some cases (e.g cholesterol drugs and contraceptives),it is possible to get up to five repeats . However, some medications allow only one, (as in some instances no repeats), requiring the patient to visit their GP every two to three months for the same basic complaint – which could be something as simple as eczema!
  4. Most employers these days require their employees to provide a Medical Certificate if they are off sick for more than one day.  You know you only have a cold, you know you just need a few days of rest in bed, you know you won’t be prescribed antibiotics (as they are now the big bad “no no” of the medical world), you know your GP will just tell you to get some rest and go next door to the pharmacy to buy cold and flu tablets and throat lozenges  – yet you still need to visit your GP unnecessarily to get a Medical Certificate so that your boss will pay you!
  5. The alleged “swine flu” epidemic.  Due the pandemonium about the “pandemic that never was”, the public were urged to see their GP even for the most mild of flu systems, and  even if they did not feel especially unwell, just in case their symptoms developed into swine flu.  This is fair enough, as if it was a genuine case of swine flu, these people needed to be taken out of circulation due to the high level of contagion it presented.  However this alone would have caused a spike in GP visits.

If you take all of these facts into consideration, it is no wonder Australian’s are visiting their GP’s over six times per year on average – but it may have nothing to do with our health worsening.

Some simple solutions could be:

Link the Medicare rebate amount to the CPI.  The rebate reduces each year by an amount equivalent to the prevailing CPI.  The cost of a visit to the GP will increase slowly over time, making Australian’s attach more value to the services GP’s provide and consider whether their symptoms really do require a face to face visit.  The safety net is still there to protect the chronically ill and concession card rates are still available to the poorer members of society.

GP clinics could employ a person specifically to deliver test results that are negative that require no further action – either face to face, or perhaps they could contact you via telephone.   This person could also be utilised to write out repeat scripts for patients. It is possible that a nurse or a medical student could serve in this capacity.

As is currently being considered, allow pharmacists to issue medical certificates where they see fit, so that only patients requiring actual medical attention go into the GP system.
 
Remove systemic abuses from the medical system:

As I alluded to in an earlier paragraph, as a visit to the GP is relatively cheap (compared to my lawyer!), once you have reached the safety net threshold, this can lead to abuses in the system by both patients and doctors.  In my previously Iife I was employed as a Medical Representative for a large International pharmaceutical company.  Yes, one of those nasty people who force GP’s into prescribing the most expensive drugs available so that large MNC’s can make ridiculous profits, and in doing so contribute to the imminent collapse of the health system as we know it!  (Just kidding, if only you knew what the job was really like!) 
 
As a result of this I sat in the waiting rooms of doctor’s surgeries over the entire state of QLD for approximately 3 to 4 hours per over a period of three years.  I would spend my time observing and talking to patients and support staff, as well as the GP’s.  Here, I witnessed some absolute atrocities.  A doctor who required a patient to attend their surgery every day to have their blood pressure tested – imagine the strain this behaviour puts on the Medicare system.  I am not a Doctor , but if you really required this level of monitoring, shouldn’t you be in a hospital?  It is yours and my tax dollars that are paying for this!  I know of other patients who have purchased their own blood pressure monitors to use at home, and only present to a surgery once their blood pressure goes over a level pre-determined by the patient’s GP. 
 
I once met a patient who advised me that he came into the surgery every day!  He was extremely proud of this fact! I don’t know if he was actually seen by a GP every day or not, but this is scary behaviour!
 
I also noticed in a large number of small country towns, that the Doctor’s Surgery seemed to be the hub of social activity.  Older people (in general) would drop in around morning tea time to say hello to the staff and their friends in the waiting room.  (Whatever happened to bingo!).  On many occasions the visit was followed by the following words directed at the reception staff, “I only popped in because I saw “X” through the window, but now that I’m here I might as well see the Dr”.  You would not believe how many times this request was granted.
 
Part of my role also included visiting pharmacies, where I witnessed even more abuses of the Medicare/PBS system.  Patients would proudly say to me (whilst I was waiting at the counter to see the pharmacist) that “I have no idea what this medication is for, but I guess I should get it filled anyway”,  or  “the Dr says I should take these, but I’m not going to, but I’ll get the script filled anyway in case he finds out !”  Any pharmacist will tell you a story about visiting the house of a patient who has passed away recently and finding up to $5000 worth of prescription medications in the ex-patients cupboard, many of which have expired and can no longer be used, that they have to remove and destroy.  This is exacerbated by the safety net in the PBS system.  Once some patients reach the PBS threshold, the can received scripts for around $5 for the rest of the year, regardless of the cost of the drug.  This leads to some patients filling as many scripts as possible before the end of the year so that come January 1, they do not have to pay the higher PBS price.  Many of these drugs will pass their use by date and end up being flushed down the toilet!
 
Once again, this could be put down to patients not valuing the service they are receiving.  Some drugs that we pay between $5 and $35 dollars for, can cost anything up to $1500 a go!  This is an extreme example, but there are many that cost in the hundreds.  The TGA looked at addressing this issue in the early 2000’s.  They suggested that the full price of the medicine be placed on the bottle/ packet , next to the actual price paid by the patient – so that the patient could see how much the Government was subsidising their medication and thus treat it with a bit more respect, i.e. to encourage patients not to stockpile expensive drugs as above.  If I memory serves me correctly, it was decided not to proceed down this path. The reason given was that some people would see this information, consider themselves a burden to society, and then either not take medication that they definitely required, or in extreme cases, might kill themselves!  I think that the Australian public needs to be given a bit more credit!
 
These are just a few examples of some of the abuses of our Medicare and PBS system that I witnessed over a 3 year period.  I can see why the system in its current form is unsustainable, and this is only the GP system, imagine what the hospitals are like!  I am sure that if some of these issues were adequately addressed million, if not billions of dollars, could be wiped off this budget breaker – without even needing to go down the unpalatable, “never happen in an election year” , path of means testing for Medicare.   I believe that the safety net systems in Medicare and the PBS are essential for the poorer people in society, those with large families, and for the chronically ill, but something definitely needs to be done to address the waste and the abuse inherent in these systems so that Australian’s do not end up losing the healthcare systems that they are so proud of and reliant upon.
 
Monique holds a Bachelor of Arts degree from Auckland University, and a Diploma of Financial Services from FINSIA (formerly the Securities Institute of Australia). Monique has also completed a Graduate Certificate in Applied Finance and Investment with FINSIA, majoring in Derivatives/Options. Monique was awarded the Bank of Queensland Prize in 2007 for achieving first place in Queensland in her Diploma of Financial Services.

Hospital Boards – true health reform starts on the ground

Terry-Barnes Abbott is heading the right way by pledging community control of hospitals, writes Terry Barnes.

Tony Abbott and Peter Dutton’s ambush of the Prime Minister last Sunday is the first shot fired by the Coalition in the 2010 election health debate.  Despite the carping of some pundits and Big Government healthcare advocates, it is an effective shot that’s characteristic of Mr Abbott.

The Opposition Leader plans to renegotiate the Australian Healthcare Agreements with the underperforming hospital systems of New South Wales and Queensland, the compacts that govern Commonwealth public hospital funding.  He wants to ensure that local hospital boards are restored and local control and responsibility promotes better management, better services and better outcomes for patients.  While some media and big government health advocates dismiss this, Mr Abbott has drawn on his own experience to respond to the concerns of the community.

In 2007 John Howard and Tony Abbott intervened to stop the closure of the Mersey Hospital near Devonport in Tasmania.  Everyone remembers the TV footage of Mr Howard being greeted rapturously by staff, patients and the local community, but the Howard government acted because northern Tasmanians were dudded by their own State government.  Until the then Prime Minister’s intervention, the community’s wishes and their support for “their” hospital was totally ignored.

But what was more popular locally than the takeover itself was Mr Howard and Mr Abbott’s decision to make the Mersey a “Commonwealth-funded but community-controlled hospital”.  It was reconstituted with the CEO, medical superintendent and director of nursing responsible to – and part of – a community board consisting of a mix of financial, legal, governance, and above all clinical skills.  Sadly, that board was unceremoniously dumped by the Rudd government in handing back operational control of the Mersey to its Tasmanian counterpart.

Mr Howard and Mr Abbott’s confidence in the Devonport community wasn’t misplaced.  Locals had the skills needed to run the hospital, they had the best interests of the hospital and its community at heart and they wanted to work realistically with the wider Tasmanian hospital system to keep the Mersey operating viably.  They benefited from in-house and local knowledge and staff support that no head office bureaucrat could hope to have.

Now Mr Abbott has drawn on his experience to give some direction and hope to the hard-pressed professionals and general staff who keep  NSW and Queensland public hospitals running in spite of, not because of, their State governments.  He understands that while Mr Rudd may talk of grand systemic reform with lots of big concepts and slogans, no major healthcare reform can succeed unless it starts from the ground up.  Local people and staff who stand up for their public hospital, and take responsibility for its operation, are more likely to give a solid foundation to wider reforms in patient management, hospital funding and quality and safety.

And if something goes wrong, as happened in Bundaberg Base Hospital in recent times, an active and engaged board, working with a CEO and senior staff, could act promptly rather than await instructions from head office.

Community control won’t solve all the problems in our public hospitals, but it’s a great place to start.  Tasmania and South Australia also have struggling public hospital systems – what if Will Hodgman and Isobel Redmond make election commitments following Mr Abbott’s lead?  It would be especially sweet for the Devonport community to see the Mersey Hospital once more under community control.

Terry Barnes was involved in the Mersey Hospital intervention as senior adviser to Tony Abbott and is an editor of Menzies House.