Menzies House

The Facts Behind The Victorian Nurses Strike

Dr. Grant Ross discusses the damaging impact of the illegal Victorian Nursing Strike:

There is nothing respectable about the nursing strike. 

The Australian Nursing Federation (ANF) voted to strike after failing to reach an agreement with the Victorian Hospitals Industry Association (VHIA), subsequent to the previous Enterprise Bargaining Agreement expiring on November 1. The ANF demanded an 18.5% pay increase whilst the VHIA on behalf of the government offered 2.5% annually with bankable productivity gains. Industrial action began November 12 and was ordered to stop on November 16 by Fair Work Australia after an application by VHIA.

The ANF defied this order and continued striking until a third order to suspend industrial action was issued November 25^th. During this period hundreds of beds had been closed across 86 health providers in the state with major effects on hospitals.

According to news reports, during the nursing strike a two-year-old girl with a broken arm had to wait more than a day for treatment after staff vacated the Casey Hospital emergency department.

Nurses refused to admit a 96 year old woman to a ward, until senior management was called in. A man at Northern Hospital waited 40 hours on a trolley.

In my hospital, 5/6 of theatres were closed, grinding theatre to a halt and forcing patients, some of whom have waited years in crippling pain, to forego operations that would have restored their ability to walk. Over 800 such elective operations were cancelled by nurses during the 13 day strike. 

Contained in a series of instructions published on the ANF website the ANF somehow gave themselves the power and expertise to decide who would and would not get an operation:

In Home Hospital Care A Real Option – Giving Back Flexibility To Those In Need & How Are Your Teeth?

Scott Lynn calls for the implemntation of home hospital care as a way to improve our healthcare system:

At a time when there are long waiting lists, over burdensome red tape, financial waste in the public health system, I believe it is worth considering implementing home hospital care as a pivotal and integral part, by taking pressure off the public system in terms of freeing up more beds and being more cost effective. I point to FINE (Friend in Need Emergency) initiative, started in WA in 2010 by the Liberal-National state government. It is an initiative in the early stages, which if proven to be rather effective, as it appears to be, will be even better when it is expanded further into the community. Those who are sick and ill, who are able and want to stay in the comfort of their home, while receiving treatment, will have peace of mind (they are less stressed and those who have greater debilitating ailments, actually get a bed in a more timely fashion). We need to cut the financial waste in hospitals, without cutting corners, otherwise, we will have the potential for greater cost blowouts. 

To do this, changes would need to be built in to the Medicare benefits scheme, permitting Doctors to administer care in the home, but changes need to be made. Research by Deloitte Access Economics discovered that being cared for in the home could be as much as 32% less expensive, in comparison to being cared for in the public hospital system as the report indicated that patients were more content with being treated at home, resulting in patients having less time spent in hospital.

Labor appears to strongly support the dependence of the state, with high taxes, government waste, broken promises, with the result of such inept governance becoming overtly accelerated contributing to increases in cost of living pressures, which is becoming a hideous trend and all too common with the current government. Labor intends to scrap (throw in the bin) the much needed Medicare Chronic Dental Scheme, which makes $4,250 available with due foresight, by trying to assist in preventing further dental (health) concerns of people with chronic and complicated oral health problems. Such a move by the Federal Government would be against the good dental care policy in Western Australia, which provides free basic dental care to those in the pre-primary years all the way up to year 11 in populated areas such as Perth and nearby suburbs and all the way through to year 12 in more remote areas of WA.

Approximately 70% of Australians access oral healthcare on a fairly consistent basis, which means 30% find it hard to access much needed preventative measures to look after their teeth and gums (dental care). Financial barriers and geographic circumstance (remote areas) provide the biggest hurdle to the remaining 30% of individuals, so cutting red tape so these individuals are not dogged by teeth and gum disease (confidence and general health complications), we should work out a path to more easily address these problems as suggested by the Australian Dental Association (ADA). ADA have put forward that we could implement an initiative named Dental Access, with the goal of focusing on providing solutions for avoidable dental problems, which cuts personal and governmental costs down the line. Direct action of this kind is very worthy, in terms of being pursued to help the 30% that can’t get access to dental healthcare, which aims to have positive long term effective dental treatment being providing, instead of the idea of a universal scheme which would give limited, patchy and rather temporary assistance, just like using a Band-Aid.  

The Labor/Green attempt to scrap the 30% Private Health Insurance Rebate, will add pressure to a public health system not in the best shape partly due to, way too much red tape (zealous government regulation), government and departmental waste, creating a disconnect between patients, those in the medical profession (including doctors and nurses of course) and the general public at large. We now see that the sooner Labor is thrown out of office at a Federal Level, the easier it will be to get back on the right track for measured and responsible government.

Scott Lynn is a 28 year old who has completed sport & recreation Admin, trained and worked in Aged Care, and is presently completing a BA in Media & Communications. 

Medical Research Funding in Australia

Dr. Michael Keane argues that government cuts to medical funding might lead to better outcomes:

Mum, apple pie and medical research funding. How could anyone sacrifice the noble efforts of dedicated, selfless scientists who are finding cures for cancer and heart disease? Amidst all the protests and indignation, there is a counterview. I am a clinician and researcher who has been funded by the National Health and Medical Research Council. There is an argument that Government cuts to funding may be entirely appropriate.

Firstly, where does the funding come from? It comes from peoples' taxes. Why not give the taxes back and let people voluntarily donate to medical research? Surely, if everyone is in agreement that the sorts of projects currently funded are so vital, the majority of people would voluntarily hand over their hard earned cash. If we accept the arguments of vocal researchers, it is a lay down misère that people will continue to support medical research; so surely there's no worries there? Wait. What if for some reason people don't want to donate their money voluntarily?  Well that should tell us something about how important people really think this expenditure is. How should capital be most effectively distributed? Do we have to re-invent the economic wheel about resource allocation? What is the benefit to an individual of investing in research that has a far off benefit that might not ever be utilized by that person. For example donating to a project that might contribute a drop in the ocean to finding a cure for cancer has to be weighed against other expenditure the person might make; such as updating their home IT infrastructure which might bring the more immediate benefit of increased work efficiency. Or even, dare I say it, a trip to the football with the family.

There is no ultimate answer as to what is the best way to allocate resources; the question is answered by the billions of interactions and decisions that individuals collectively make in their lives. Maybe people value short term gratification more than the long term benefits that research may  bring. We don't forcible make someone undertake a course of action in order to further someone else's health. That would immediately be recognized as contravening basic medical ethics. But can we trust "ordinary" people to understand how important  research is. They might be too "stoopid" to effectively allocate their resources. The "elite" believe that they must make those decisions as the "ordinary folk" might not make the right choices! While that rationale may sound utterly condescending, it is, unfortunately, at the very core of those arguments that call for ever more Government funding for research.

The second reason that it would potentially be a good thing to slash Government funding is that many of the projects that are funded are complete rubbish! But how do we decide which projects are worthy and which are not.  People will tend to donate to projects that are seen to be more relevant. How will people know which are more relevant when they don't have expertise in the area? It will happen the way resources are always allocated. People will develop confidence and trust in certain institutions and will be likely to follow their recommendations. 

Conversely, the current system is probably the worst way to effectively allocate scarce resources. That is, having "experts" undertake the sometimes farcical exercise of determining what is a "better" project. This bureaucratic "Yes Minister" approach flaunts everything we know about the human conditions and decision making. We accept that judges, economists and politicians make decisions on the information presented to them based on their pre-conceived ideas. Committee members deciding on which grants to fund are no different. Researchers and clinicians can spend decades debating the effect of a single drug. Yet there are impossible combinations of indices to consider when judging the worthiness of research grants. Thus, it is unrealistic to believe that some system of objective measures can simply be applied to work out which are the most important projects. In this regard, opinion is always going to be the dominant factor.

While invoking the concept of Yes-Ministeresque, strangulating bureaucracy, it would be naïve to think that which grants were funded was not a function of who the committee was stacked with. Like every industry, there is certainly an in-crowd. With peoples' careers, reputations and livelihoods on the line depending on funding decisions, it would be somewhat unbelievable to think that the right connections are not important. This may play out at either a conscious or subconscious level, but we know that this is an inevitable part of such a system; i.e. any system that involves deciding how to spend other peoples resources. Ideology plays an important part. Should we, for example, be funding more or less indigenous health projects. I study (amongst other things) the effects of illicit drug use. I accept however, that many people think less money should be spent on that and more on cancer. The question entails fundamental value judgments including consideration of where peoples' individual responsibility should be in respect of things that they can and can't change. But at the end of the day, let people vote with their hard earned. Otherwise we merely have an entrenched, narrow, ideologically based system which is immune from community expectations. If you drew a distribution of the ideology and political persuasion of health academics and that of the general population it would probably not be the same.

The current, insulated in-crowd-oriented system of medical research funding has incredibly inefficient practices entrenched within it. Every other field of human endeavor has realized that such bureaucratic systems actually cause a decrease in productivity. Maybe it's time for a clean out of the system.

Dr. Michael Keane is an anaesthetist and researcher with interests in illicit drug use and drug policy, bioethics and public health. He is also a lecturer in public health at Monash University. 

Rethinking Australian Health Care Policy

Dr. Michael Keane argues for a radical rethink on health policy, and a move away from third-party-payer funding to allow price signals to install market discipline:

With healthcare reform continually on the political agenda, debate typically centres on ways the government can increase funding and services.  In this regard, concepts such as Medicare Locals, local hospital boards' involvement and state-commonwealth funding arrangements make Monty Python's classic piece about the People's Front of Judea seems especially relevant.

The relevance being the folly of believing that committees can efficiently run such a complex system without being bogged down in unsolvable squabbles, politically and ideologically driven turf-protection and strangulating bureaucracy. What is so desperately needed, but rarely discussed, is a move away from reliance on third-party-payer funding and allow price signals to install market discipline.

Listening to health experts, it is tempting to accept that impartial analysis of objective data inevitably demonstrates the necessity for increased government funding as the answer to our failing healthcare system. However, the reason healthcare reform is framed almost exclusively in terms of government funding is a function of the prevailing ideology within academic medicine in Australia; an ideology of staunch collectivism.  Appeals from academics for more government programs are predicated on the questionable assumption that committees of experts can effectively allocate resources.

The doctrine of “universal health care” (or waiting until the end of the universe to see a doctor or have your operation) is held with such absoluteness that it is considered unpalatable to even consider the concept of the more you consume, the more you pay. The retorts are predictable and extreme; people will be dying in the street because they can’t afford to see a healthcare provider.

Green Medicine and the Politics of Public Health

Nick Sowden discusses the relationship between "public health" and the green-left desire for overregulation:

This morning I was casually checking my email when I came across an interesting little number forwarded on for the group ‘Doctors for the Environment’. It was sent endorsing the Doctors for the Environment’s rather modernly clichéd Student Conference entitled ‘iDEA’(yes, small ‘i’ and all). I was somewhat curious as to what this conference would involve and so decided to click on the PDF attachment. What sprung to life on my iPAD (wait, now I get it) was a bright green poster with the names of a few speakers.

Greens Senator Christine Milne will be in attendance, so will Dr Linda Selvey, the CEO of Greenpeace Aus-Pac and a Public Health Physician. Joining them is Dr. Richard Deniss, Director of the progressive think tank - the Australia Institute who is described as “an economist with a particular interest in the role of regulation,” who “has also worked as Strategy Adviser to the Leader of the Australian Greens, Senator Bob Brown.” Also there to spruik the environment to young doctors is Professor Garry Egger the author of Planet Obesity: How we're eating ourselves and the planet to death, in which he “links obesity with consumerism and climate change.” Rounding off this list of speakers is Dr Merryn Redenbach, who is a Paediatric registrar and Sea Shepherd ship’s doctor.

Unsurprisingly this hardly made me want to attend this event; however it did demonstrate rather elegantly the link between the left-green movement and Public Health nationally. Whenever there is regulation to be introduced to save us from ourselves, look no further than the Greens. It is hardly surprising that in a country which clings so helplessly to its public hospital systems, the ‘cost’ of public health is often debated. Indeed, the supposed idea of equality of health care works two fold, first to allow access to all, second to increasingly control what people can and cannot do – all in the name of health care.

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)

Health can be Baillieu's policy trump card - Terry Barnes

If Baillieu's Coalition cannot break Brumby's grip soon it risks more years in the wilderness. Whatever policies it releases before the election, it needs to have at least one barnstorming idea that Brumby can't match, won't steal, and will cut through to capture voters' imaginations.

There is one such idea ready to adopt and simple to understand. That's to do what Brumby eventually didn't: stand up for Victoria and reject the Rudd health deal.

It's generally thought that the Commonwealth and Labor states have entered into a binding and enforceable contract on the division of responsibilities, governance and funding arrangements for Australia's public hospitals. Not so. What we have is at most a loose and non-binding statement of intent. There is no formal compact, and for the time being there is no federal or complementary state legislation to back the COAG agreement, including promised additional federal recurrent funding beyond 2013. Nor is there as yet any federal legislation to claw back one in three GST dollars to bring the federal share of public hospital capital and recurrent funding to 60 cents in the dollar to which Rudd committed what was then his government. Without these the deal's not worth the paper it's written on.

Baillieu is not bound by Brumby's signature. Nothing prevents him promising that, if elected, his government will reject the inferior COAG outcome so meekly accepted by Brumby. His first move as premier can be to start fresh negotiations with the now prime minister (and fellow Melburnian) Julia Gillard to get a fairer go for Victoria and its public hospital system which, for all its many faults, is envied across Australia. This includes preserving Victoria's activity-based hospital funding and local board governance that's superior to anything proposed by Rudd, Gillard and federal Opposition Leader Tony Abbott.

via www.theage.com.au

Terry Barnes is a contributing editor of Menzies House. Click the link above to read the full article at The Age.

Medinet Madness

There is no doubt anymore good reader, these ALP fraudsters and spivs are running scared from Tony Abbott, and the proof has to be in the announcement of rubbish policy like this.

Apart from the physical impossibilities of performing an accurate "physical examination" via a two dimensional medium such as the Internet and the obvious disadvantage this service would be to anyone who does not have such technology at home, what about the bloody costs to the practitioner and then the patient.