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Monday Message Board

May 19th, 2014

It’s (long past) time for another Monday Message Board. Post comments on any topic. Civil discussion and no coarse language please. Side discussions and idees fixes to the sandpits, please.

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  1. Megan
    May 19th, 2014 at 10:14 | #1

    Australians are very protective of our excellent universal healthcare system. Free market ideologues underestimate that attachment.

    I had no idea that our first neo-con PM, Hawke, introduced GP co-payments in 1991. Arguably that allowed Keating to finally overthrow him and a few months later it was dropped.

  2. Terje
    May 19th, 2014 at 12:18 | #2

    I would not call the Medicare system excellent but Australians are very protective of it. One of the reasons I think they are protective is due to fiscal illusion. The Medicare levy tricks people into thinking it’s a cheap scheme and hence a bit of a bargain. I propose we increase the levy to 10%, which would reflect the real cost, cut the general income tax rate to compensate and then in a year or two ask people again how much they like the Medicare system. I suspect the response would be very different.

  3. I used to be not trampis
    May 19th, 2014 at 13:03 | #3

    wow Terje I would.

    On any basis the system produces very good results at a low cost.

  4. David Allen
    May 19th, 2014 at 13:09 | #4

    I’ll take you up on that too Terje. Can we also put a defence levy up so we can see the enormous waste on war-toys. Which do you think people will demand be lowered?

  5. zoot
    May 19th, 2014 at 13:15 | #5

    @Terje
    Yeah, count me in.
    But we must include ending the subsidy to private health insurance companies. Mustn’t have any hidden factors.

  6. Troy Prideaux
    May 19th, 2014 at 13:24 | #6

    Megan :
    I had no idea that our first neo-con PM, Hawke, introduced GP co-payments in 1991. Arguably that allowed Keating to finally overthrow him and a few months later it was dropped.

    Worth noting however that Keating started out in politics righter that my golf slice and stayed there for much of the 80s.

  7. Megan
    May 19th, 2014 at 15:04 | #7

    @Troy Prideaux

    To be clear, Keating was our second, Howard our third…etc..

    I didn’t even realise the ALP had tried it on under Hawke until today, but my guess is that Keating dropped it because it was deeply unpopular rather than because he disagreed with the concept.

  8. May 19th, 2014 at 22:30 | #8

    TerjeP’s idea is silly and indicates how little he understands health insurance systems. Most single payer systems have some mixture of general revenue, private revenue and direct insurance contributions – see e.g. Japan’s, which delivers the best health in the world at very low cost, and with limited inequity. This is because funds from general revenue enable these systems to mitigate some of the problems that arise from out-of-pocket (private) revenue and direct insurance contributions. Of course TerjeP doesn’t understand that because he lives in a private universe of his own construction.

    In any case TerjeP’s proposal is highly unlikely to turn anyone off medicare. It would simply make medicare have a funding situation similar to the Japanese, German and French systems – all of which are very popular with their own populace. It would hardly cause the uproar he thinks, because the reason medicare is popular has nothing to do with its supposed fiscal illusions.

    There are some good arguments in favour of copayments. Certainly compared to Japan a $7 copayment would be small beer, and Japan has highly equitable health outcomes.

  9. Ken Fabian
    May 20th, 2014 at 10:17 | #9

    Most GP’s around here don’t bulk bill – with another $7 a visit would push the up front cost for uninsured to up around $20. Plus getting there and back and prescriptions to fill and potentially follow up visits – first consultation then tests then second consultation for test results and actions arising… it quickly inflates to a lot more than the cost of a couple of beers!

  10. May 20th, 2014 at 10:17 | #10

    A Joe Hockey’s contradiction on last night’s Q&A seems to have escaped attention. He claimed, I believe, that the infrastructure spending was the Government’s principle strategy to create jobs. Later he declared governments do not create jobs.

    Increasing unemployment is one of the successes of the Abbott Government, from car workers to public servants while reducing support for the unemployed. Joe Hockey evaded the hardship people will face without support other than private charities. The next government will have the option to set up a royal commission should any deaths result.

    I notice he made no rhetorical references such as “small governments make individuals large”, which he regaled his party fundraising audience, almost immediately after delivering the budget speech. That timing might well be the established practice in Canberra, and for that reason unremarked, but given the findings of ICAC in NSW and the connotation “Liberal Party Fundraiser” has now acquired, it might be seen in a different light.

  11. May 20th, 2014 at 10:35 | #11

    Ken, in Japan I think $20 would be the basic pre-insurance price for a standard trip to the doctors, with drugs. In terms of reducing unnecessary service use, $7 is probably too high, especially in areas with limited bulk billing. It would be a fairer decision if the budget had also introduced a requirement for all surgeries to bulk bill…

  12. Ivor
    May 20th, 2014 at 10:46 | #12

    @Terje

    Why do we always get nasty people who want to increase costs using fake claims such as:

    “10% would reflect the real cost.”

    Evidence or Terje-dogma? Why not 10.5 or 11%? Why not 9%?

    In effect Terje is arguing for a system where everyone only gets what they pay for – except capitalists who always get more than they pay for.

  13. Collin Street
    May 20th, 2014 at 12:38 | #13

    > Japan has highly equitable health outcomes.

    Japanese health statistics are not hugely reliable.

    http://blog.nus.edu.sg/dsap/2010/08/04/japans-chowty-dars/

    [there are other problems: there's some evidence that japanese doctors may not be as skilled as in other countries, there's significant populations of extremely marginalised people -- homeless or in extreme poverty -- that tend to get missed, etc.]

  14. May 20th, 2014 at 15:43 | #14

    Checking with the program transcript, here is Mr Hockey’s relevant statement (Q&A:Tasmanian Youth Unemployment, 00:45:10)

    The private sector employs people. So what we’ve got to do is lift the economy – lift the economy so that the new jobs are created, right? That’s a starting point and one of the things we’re doing, for example, in Tasmania, is we’re spending a lot of money on infrastructure and we’re spending a lot of money on new initiatives that are going to help to create those jobs.

    While presumably acknowledging governments do employ people, including himself, it is not desirable that they be the direct principles in the economy as employers, although they pursue spending policies that lift the economy. The fundamental discussion is role of government and the role of corporations and their inter-relationship, including political donations and access to formulation of public policy. The ICAC reference is apposite.

    (This comment perhaps should be in the Sandpit or somewhere else)

  15. May 20th, 2014 at 15:55 | #15

    In the face of two anecdotes, Collin, Japanese health statistics are generally well-respected internationally, and Japan’s relatively low inequality is well understood. There’s a body of literature on this, you know. There are not “significant proportions” of extremely marginalized people in Japan – and there are certainly no statistics to back up this claim. Unless you want to claim that Japan’s entire vital registration system is broken (which you will be doing without evidence), I’m afraid it’s difficult to dispute the findings on health equality.

  16. J-D
    May 20th, 2014 at 16:46 | #16

    The results of a quick Web search suggest that the stigmatised ‘outcaste’ group known as burakumin could make up 1% or 2% of the Japanese population. Whether that’s a ‘significant’ proportion, I suppose, depends on your purposes. There’s definitely some basis for calling them a ‘marginalised’ group, although I expect reliable information about how their access to health services compares with that of other Japanese might be harder to come by.

  17. May 20th, 2014 at 17:52 | #17

    Good luck finding evidence of discrimination against burakumin in healthcare, J-D, or any evidence of a modern Japanese person who knows of any way to discriminate against a burakumin. And what exactly is the link between that and the relationship between Japanese healthy life expectancy and upfront healthcare payments?

  18. J-D
    May 20th, 2014 at 18:48 | #18

    @faustusnotes
    Everybody knows how to discriminate against a person. It’s not a difficult thing to do. I don’t know why you imagine modern Japanese people would be an exception to this.

    I don’t know that there is any link with the subject of health care or healthy life expectancy. Maybe there isn’t. But I felt that in the context of your more general assertion about marginalised groups in Japan it was worth drawing attention to the existence of one. There are others, of course. I hope they all receive excellent health care. Maybe they do. But many people outside Japan are not even aware of the existence of burakumin, for example.

  19. sunshine
    May 20th, 2014 at 19:33 | #19

    Japan is often said to have had 20 years of stagnation ,wasted decades ,but to me it seems it would have been be a comparatively good country to live in. Everyone I know (including me) who has been there has loved it .Failure to achieve maximum possible growth is really frowned upon.

    It is frustrating that the Libs seem to be taking us down this libertarian road without being forced to clearly say so ,or explain why .They seem to be able to simply say ‘if we didnt have the courage to make the cuts now we would only have to make them later when it will be harder to do so’ .Like making the least able pay is the logical, and only, option. How can they say 500$ for 3 years for someone on 150k+ is sharing this burden- it is insulting .It is depressing to think Australians could even come close to swallowing that. The Coalition are changing the very nature of this country (yes Labor has played a part too) ,the fair go will be gone .They have no mandate to do it .For the near future we are stuffed -lots of opposition will only get it watered down a bit at best. It will still be steps in the I.P.A. U.S.A. direction.

  20. May 20th, 2014 at 19:54 | #20

    I dont’ know if I’d call the Japanese health care system the best in the world. I’m not saying it’s bad, it’s just that my impression is it could be a lot more perfecter than it is. But in terms of actual health, Japan is at the front of the world along with weird places like Hong Kong, Italy, and Australia.

  21. May 20th, 2014 at 21:04 | #21

    I propose we increase the levy to 10%, which would reflect the real cost

    The levy would then need to be roughly 10% of the taxes, not 10% of the income. So I guess shifting it from 2% to 3-4% might be a better reflection. However, if you include the surcharge, it comes pretty close to being that anyway. So if we remove the mechanisms that funnel money to the insurance companies (roll surcharge into the levy & remove insurance rebates), we’re basically set.

  22. plaasmatron
    May 20th, 2014 at 22:28 | #22

    Having lived in Australia and Japan I can attest that both systems are good. The Japanese system has people covered for 70% of their health bills up to a set limit, IIRC. THis has the advantage of not encouraging people to go to the doctor unless neccessary, but not bankrupting any who can’t afford it. The doctors in Japan were generally excellent (at least in Tokyo).

    Terjes idea of having a levy to reflect the cost of the system is ineffective. Germany, where I now reside, has a similar system where 15% of your wage is deducted toward health insurance. It is not called a tax or a levy but “insurance”. This creates the impression that one should try to get something back from their insurance “levy”, and has people visiting the doctor when not absolutely neccessary. Many old people go to the doctor for a chat because they are lonely, and because the figure they have paid for it already. (Incidentally, just this year Germany scrapped the €10 quarterly upfront visiting fee (payable on the first visit to your GP per quarter) because it was an administrative quagmire.)

    Of the three systems I have lived under, Australia’s medicare system is easily the best. The main reason is that the money for the system comes out of the general tax pool. One does not think that they should get something back from their insurance or levy that they paid for. Maybe more important is that Australians have a (generally) healthy lifestyle and good climate and are encouraged to stay fit instead of thinking that there is a medical cure for our vices.

    It seems perception is a very important part of the efficiency of a health system, both on the part of the doctors and the patients/populace. Actually the verb from the German word for tax (Steuern) means “to steer”, which creates a good perception, whilst the German word for debt (Schuld) also means “blame”, “fault” or “guilt”, which obviously has negative connotations.

  23. jungney
    May 20th, 2014 at 22:57 | #23

    Medicare is fantastic. I’ve used it for a double hernia repair and a manual removal of a kidney stone. Both ops were incredibly painful. Both ops, post op, saw me given the arse from the hospital well before I ought to have been discharged in the name of efficiency and the new policy of ‘get ‘em up and get em moving and outta here’.I toughed it out. If I had been a US resident I would have been dead or choosing death in either circumstance.

  24. May 21st, 2014 at 00:08 | #24

    @jungney

    And/or you would be bankrupt.

    “Medical bankruptcy” (yes, it has a name in the US) is the leading cause of bankruptcy in the US at about 60% of all bankruptcies, and that includes smug people who believed that because they had “insurance” it couldn’t happen to them – until they found out about the ‘co-payments’ etc.. that aren’t covered.

    In the US you might get a bill for $34,000 for a few hours of anaesthetic on top of the cost of surgery, hospitalisation etc…

    As a teenager I did something stupid and had a nasty compound leg fracture. Ambulance was free, hospital was free (a few weeks spent there), an orthopaedic surgeon (one of the best in the city, I was later told) did the complex operation inserting a plate and screws for free, treatment for the aviral pneumonia I picked up was free, out-patient and surgery to remove the plate a year later – all free.

    I pay taxes for this and I’m buggered if I’m going to let some neo-con fascist take it away from me and anyone else who might need it.

  25. May 21st, 2014 at 00:19 | #25

    Would the world end if Australia went back to being a high taxing country with proper medicare and free universities?

    That is, has the world changed in such a way that we would be ruined if we did this?

  26. May 21st, 2014 at 00:22 | #26

    On reflection, I think I did get a bill for the ambulance – about $120 and they were very relaxed about it, I think I paid it off over a few months once I “got back on my feet”.

  27. rog
    May 21st, 2014 at 06:45 | #27

    Battle lines between conventional and solar are intensifying and the banks are involved.

    UBS said in a report last week that while removing solar incentives may cause a short term fall in the take-up of rooftop solar, by 2018 the continued fall of solar costs, and the emergence of storage as a viable option, meant that average households might find it cost competitive to leave the grid entirely.

    They, like other investment banks such as Citigroup, Deutsche Bank, Morgan Stanley and Goldman Sachs, say the emphasis is on the incumbent utilities to evolve.

  28. May 21st, 2014 at 08:18 | #28

    Hi everyone, if you are interested in defending Australia’s health system from Tony Abbott, here is a link to a letter from the Australian Health Promotion Association to Tony Abbott. http://www.healthpromotion.org.au/images/stories/AHPA_letter_to_Ministers_BUDGET_2014.pdf

    The Association is urging people to write to ministers and MPs and sign petitions. I will send further links separately.

    The cuts to public health and health promotion are egregious. It looks as though the government decided to go after all programs that were set up by the former government, regardless of how well founded. It looks as if they then got worried about the backlash and decided to set up the half baked medical research fund.

    That’s one explanation anyway. Another is that all this part of a shift towards a privatised, commercialised model of health (like what the US is finally trying to get rid of, for all the reasons you have mentioned above). The medical research fund could well fit with that also.

    It could be a mixture of all three: political revenge, fear of backlash, and long term profit-making/privatising agenda. It seems to be an extraordinarily ignorant and confused approach.

  29. I used to be not trampis
    May 21st, 2014 at 09:30 | #29

    Mr Brookes,
    Australia has NEVER been a high taxing country! NEVER.

  30. peter
    May 21st, 2014 at 10:05 | #30

    Interesting to see the Social Progress Index developed by MIT researchers as a means of international measurement – outside of economics/GDP – coming out with Australia (10th) Japan (14th) and the US (16th). NZ topped the list despite a per-capita GDP of two thirds the US figure.
    The SPI measures three abilities of a country – capacity to deal with basic human needs, institutions
    to enhance quality of life and an environment for citizens reaching full potential.
    In the face of climate change I can see a lot more consideration of ‘standard of living’ declines in the future with efforts like the SPI to ‘compensate’. (Huffington Post have a link.)

  31. Hermit
    May 21st, 2014 at 10:07 | #31

    @rog
    This sounds eerily like the return of the prophet in the not quite imminent future to guide us from the wilderness. A reality check is that PV installations have nosedived since 2012. See Clean Energy Regulator REC-Registry/Data-reports. As for energy storage breakthroughs I hope it’s neither the Tesla mass produced lithium battery or newer batteries like double carbon. The former is not that cheap on a lifecycle basis and the latter hasn’t been tested in public. Considering factors like possible lack of carbon tax, the gas price and economic downturn we’ll probably burn about the same amount of coal in 2018 as we do now.

  32. May 21st, 2014 at 10:24 | #32

    @Collin Street
    A country’s mortality stats are virtually unfakeable, and are a pretty good guide to general health rates; and Japan is definitely in the top bracket there – fractionally ahead of Australia for males, materially ahead for women. I wouldn’t necessarily attribute much of that to their health insurance regime, though – much more is probably due to their comparative equality.

  33. May 21st, 2014 at 10:49 | #33

    The petition mentioned above
    “Fund health and medical research with a universal, progressive and FAIR tax – NOT with a GP tax ”

    is here
    http://www.change.org/en-AU/petitions/hon-joe-hockey-fund-health-and-medical-research-with-a-universal-progressive-and-fair-tax-not-with-a-gp-tax

    I hope some of you will consider signing it

  34. May 21st, 2014 at 12:02 | #34

    has anyone seen this image of Abbott winking – horrifying

    http://www.theguardian.com/world/video/2014/may/21/tony-abbott-winking-video

  35. May 21st, 2014 at 12:15 | #35

    @I used to be not trampis

    Australia has NEVER been a high taxing country! NEVER.

    I was (perhaps mistakenly) under the impression that income tax rates used to be higher. Is this wrong?

  36. TerjeP
    May 21st, 2014 at 13:53 | #36

    David Allen :
    I’ll take you up on that too Terje. Can we also put a defence levy up so we can see the enormous waste on war-toys. Which do you think people will demand be lowered?

    Hopefully they would demand we lower both.

  37. TerjeP
    May 21st, 2014 at 13:58 | #37

    “10% would reflect the real cost.”
    Evidence or Terje-dogma? Why not 10.5 or 11%? Why not 9%?

    Any of those alternate numbers would still be far more indicative than the current 1.5%. However the figure seems to be closest to 10%. To calculate this is quite simple.

    Adjusted rate = 1.5 x (federal health expenditure / revenue from current Medicare levy)

    You can get the numbers from the budget. But I’ve saved you the trouble and done the math and the answer is that a more honest Medicare levy would be 10%. Of course you could just abolish the Medicare levy instead and stop pretending it means anything at all.

  38. TerjeP
    May 21st, 2014 at 14:01 | #38

    Slightly different topic. This article on e-cigarettes caught my eye.

    http://www.theguardian.com/society/2014/may/20/e-cigarettes-nicotine-patches-smoking-study

  39. May 21st, 2014 at 14:52 | #39

    I can’t imagine that e-cigars would catch on.

    Just wouldn’t be the same as the real thing.

  40. Debbieanne
    May 21st, 2014 at 15:15 | #40

    @Val
    That man has always made me sick.
    Unbelievable, comes to mind, but is not really the truth.

    thanks for the petition link

  41. I used to be not trampis
    May 21st, 2014 at 15:19 | #41

    Mr Brookes if you are simply talking about income tax that is different to taxes as a whole

  42. J-D
    May 21st, 2014 at 15:59 | #42

    @John Brookes
    In the absence of more specific contextual information, the meaning most likely to be suggested by the expression ‘high-taxing country’ is that of a comparison to other countries, not of a comparison to the same country at a different point in its history.

  43. May 21st, 2014 at 17:06 | #43

    @Debbieanne
    no I agree sadly it isn’t unbelievable – but still sets your teeth on edge doesn’t it.

    Someone I know commented that he has all the signs of a one term PM – that could be the upside I guess

  44. derrida derider
    May 21st, 2014 at 17:11 | #44

    @John Brookes

    We used to get a much bigger proportion of our revenue from income tax than other countries did (not so true now), and income tax is the most visible tax. Hence the popular impression that but our tax take was large rather than the small one by international standards that in reality it was and is.

    We currently, for example, raise about the same tax as a percent of national income as the “small government” US does (the US actually spends more than us because the gap between revenue and spending is larger there). Of course that’s after you take state level taxes in both countries into account – the Yanks have a lot more of those than us.

  45. sunshine
    May 21st, 2014 at 18:54 | #45

    Apparently the budget is far less popular with women than with men. If I could guess ,I think that is worth investigation. I think its probably part of a wider phenomena whereby ,to our peril in the longer term ,characteristics generally considered feminine are underrepresented in the public policy arena since those generally considered masculine successfully exclude them. Abbott is blokey in the extreme -wink ,wink.

  46. May 21st, 2014 at 20:08 | #46

    @sunshine

    Maybe a reflection of the number of woman involved in drawing up the budget?

  47. May 21st, 2014 at 21:05 | #47

    I see Shrek has sued Fairfax over the “Treasurer For Sale” stories about the North Sydney Forum (or whatever it was called – the point is for $22,000 you get a certain amount of quality time with the treasurer, Hockey).

    The things have an unfortunate way of dwindling away or getting settled confidentially. In this case I think it would be lovely if Howard’s defamation amendments got a run. Howard essentially removed the dual test for a defence to a defamation action. Previously you could publish something that was defamatory of someone, and if sued you could defend the action on the basis that what you published was ‘true’ and ‘of public benefit’.

    Howard’s ‘Murdoch’ amendments removed the tricky requirement that you prove publication was to the public benefit – it simply has to be ‘true’ and away you go.

    I’m guessing the Murdoch, and other establishment media, opinionaters will suddenly forget their screeching over press freedom vis-à-vis Bolt’s “right” to vilify people (using untruths) on the basis of their race.

  48. May 21st, 2014 at 21:19 | #48

    @Megan

    The cigar smoker is probably upset that he is being called out. I mean, why fork out a lot of money if it won’t get you anything? The people who pay for access would be furious if it got them nothing.

  49. May 21st, 2014 at 21:23 | #49

    But back to tax. It seems that we don’t tax less than we used to, but since we seem to have a structural budget deficit, we must be spending more than we collect.

    So I guess the question becomes, “If we want to spend more, can we tax more without significant harmful effects?” I’d like to have an opinion, but I don’t know anything about this.

  50. J-D
    May 21st, 2014 at 21:33 | #50

    @John Brookes
    There are countries where the total amount collected in taxation is a substantially higher fraction of GDP than is the case in Australia, so clearly it is in some minimal sense possible. Whether they suffer significant harmful effects as a result is another question.

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