Doctor and activist


Notice: Undefined index: hide_archive_titles in /home/chesterf/public_html/wp-content/themes/modern-business/includes/theme-functions.php on line 233

Category: Insurance

iCare= Hopeless in Two Reports but the Bad Joke Continues

30 April 2021

Two reports on iCare have come out on the same day- how convenient, one lot of publicity rather than two.The report of the Parliamentary Committee was one report, the other was a report by Robert McDougall, a retired Supreme Court judge.The political report looked at the disgraceful evidence given by John Nagle which showed almost no care for the injured workers and an appalling attitude of entitlement in him and his crony staff. iCare had not even known what workers’ Pre-Injury Average Weekly Earnings (PIAWE) were, and had not tried very hard to find out so that they could underpay them and minimise their costs. They relied on computer algorithms rather than staff to manage the claims, only getting staff on the case if there were problems, which there usually were, as the poor patients were having their treatments delayed or denied.
The McDougall report had its terms of reference set by Treasury, who were also the department being investigated, and they also staffed the inquiry. The Treasurer, Dominic Perrottet did not agree to be interviewed by McDougall and got away with this. Is this some sort of bad joke? The McDougall report found incompetence etc, but no actual corruption that anyone could be charged with. As such, the McDougall report was a political success. It took the heat off the Treasurer from November to now, and will result in a bit of publicity, no serious recriminations and the usual promises of future action. John Robertson, an old union hack is the new CEO, so Labor will not criticise iCare now.
My poor patients will be mucked around, be underpaid and have their treatment denied as usual. And Treasurer Perrottet will sail on hoping to be Premier as Gladys falls. What a joke!


www.abc.net.au/news/2021-04-30/damning-reports-released-over-nsw-icare/100107076?fbclid=IwAR34I_blTADSxa2OoWxrzOpvgNPZ3KUFmhQmpSFZHd4LSOIVdof0nx8yMGs

Continue Reading

Labour Hire Companies facilitate Wage Scams

5 April 2021

When I was in Parliament the then NSW Labor Government had an inquiry into WorkChoices, which was the Howard Federal government’s preferred industrial relations model. It was, as the Liberals said, an political inquiry designed to criticise what Howard was doing. (Historians will recall that it cost the Howard government s lot of votes).

But both Unions and Employers came and lobbied me, as did Labour Hire business owners. The Labour Hire companies said that they could get a better deal for the employees as they were negotiating on their behalf with employers and if they had special skills the employers would have to pay for these. I asked them how much commission they took on this as obviously employers would have to pay their commission as well as the subcontractor’s payment. They were very reluctant to be specific on this point as it was ‘variable’. But it did seem to me that the chief objective was to make the worker a private subcontractor rather than an employee and thus remove award pay rates, holidays, sick leave, workers compensation, and bargaining power. The Labor Hire company was often just a commission agent, though some employed the workers.

It seems that this model of getting rid of direct employees has evolved and is now standard in many industries. I have seen a woman accidentally stab herself in the forearm while boning chickens at 3.30 am on a 12 hour shift, a man shoot himself in the heart with a nail gun trying to assemble flat pack kitchens alone and RSI in a hotel worker so advanced that it has made no recovery in 3 years, after being expected to clean high-end hotel rooms, including making the bed, vacuuming and cleaning the bathroom in 12 minutes each.

‘Subcontractors’ may have no awards, no unions, no OHS and no redress when people are ripped off. The lumbering ‘Fair Work Commission’, out of sight and out of touch seems to make very little difference to a Darwinian model.

Let us see if criminalising wage theft makes any difference. There are a lot of laws on the books that are never enforced.

https://l.facebook.com/l.php?u=http%3A%2F%2Fwww.smh.com.au%2Fbusiness%2Fworkplace%2Faustralia-s-shocking-wage-theft-scandals-keep-coming-by-the-truckload-20210312-p57a5p.html%3Ffbclid%3DIwAR3FoKWzuLj-nv9W5moUs7K-HmlfV8msxTXhOicq62KM83zMerzWwcFiJYM&h=AT3RrEZXGjEyZeQ7rNBoGGgl9Flo0_zzfDuqRAnUxguMlUcU-J9oiuQGDpT01vJnqPsdtFErgLw0g92bkmtQt_TQ-vPzVqPsWvYaVFbIYosdg1YBYAm5Fke4e4-OdaDB8JwYckGgwuhNR5mltMZO&tn=-UK-R&c[0]=AT2ipxj2y11laB8hdM-suLNA2ij5tamnMBYbjAGX5r25jhtlSzzvd-Dn6kj1lQ88fBiyw1dyFFnNXi8tEuTfOVY_74RgrorvDvqc2EuyAIWBJMbsZjzjqyCneyp7HOlhnr8r_bd9dZtlDER2pMrWsThzMw
Continue Reading

iCare Doesn’t Know and Doesn’t Pay Underpaid workers

7 March 2121

The incompetence of Perottet’s iCare never ceases to amaze.

It underpaid injured workers but was not sure how many. It was initially 240,000. Then it changed its to estimate to 52,000 people underpaid up to $80 million. Then possibly as little as $5 million. In March it is 23,000 and $20 million. They don’t actually know. After 18 months 25 have actually been compensated!!!
This is all treated as some of ‘management error’ as if this makes it OK. These are a lot of abstract words, but few concrete ones. The idea of abstract words is that the concepts can be discussed better. But mostly management words are so general as to be meaningless, and principally serve to make everything non-specific and also euphemistic. No one says, ‘They did not know or care and their incompetence led to immense suffering for the families who were underpaid’. It becomes, ’There was a lack of management understanding and focus and some workers may have been paid less than their entitlement’.
Naturally no one will be punished.
All I know is that even the routine service takes about 3 weeks to get anything done. I had a patient doubly incontinent after a spinal injury. It takes up to 10 working days to get a claim approved, then up to 10 working days for them to approve an MRI and a specialist consultation. This is normal. When they delay things it is worse, and sometimes they refuse to pay at all.
www.smh.com.au/national/nsw/scathing-icare-review-finds-a-need-for-cultural-change-20210301-p576tq.html

Continue Reading

Scathing PWC Report Finds Perottet’s iCare Incompetent

6 March 2021

A 100 Page report by consulting from international PWC (Price Waterhouse Coopers ) found weakness in performance and governance, and the Board did not hold management to account. 

We might also consider that the Minister, Dominic Perottet did not hold the Board accountable, and appears to show no interest at all in the injured people for whom the whole scheme supposedly exists. We might note that no doctors or patients appear to have been interviewed either- Hey, it’s all about money you know!  One could ask why PWC did a report when Justice McDougall was simultaneously doing one that it coming out in April?  Perhaps he is a lawyer and does not know enough about money.

The bottom line is that it was run from the top by people who only knew about money with little input about its proper function from the people at the coal face, who presumably should have some knowledge of the people that they are supposedly helping.  (I say that with reservation, as the case managers that I deal with have high turnover, little insight and seem to assume that a large percentage of their cases are fraudulent, the doctors are hell-bent on inventing pathologies to over-treat and they have to follow elaborate protocols designed to ensure that no one could under any circumstances get one cent more than was absolutely necessary).

So we digest the Management-speak of this report and await the McDougall report which had terms of reference that allowed little input from patients or doctors, held no hearings and seemed to exist principally to take the heat off the Minister from last August until its April release.

It seems that there has been a generic concept since the 1980s that managers know best, that other degrees and knowledge from lesser beings or lesser ranks and incomes are not of value or to be listened to.  It has come unstuck in so many situations that its time that some little boy (or girl) points out that ‘The Emperors have no Clothes’.  Then we can go back to an older time, where people had appropriate training, worked their way up, knew their jobs, were promoted on merit and had small salary increments reflecting their incremental status rise.  But I suppose that this would rely on people having permanent jobs and depower the whole new managerial class and their symbiotic consultants and reduce the workplace ‘flexibility’ that allows the obscene salaries at the top and insecurity at the bottom. 

If Anglo society does not want to fall to more realistic societies in Germany and Asia, there needs to be a large rethink of the Harvard 1980s management nonsense that is the foundation of these sort of debacles.

www.smh.com.au/national/nsw/scathing-icare-review-finds-a-need-for-cultural-change-20210301-p576tq.html

Continue Reading

JobKeeper becomes an Unaudited Subsidy to Big Business

6 March 2021

It seems that while JobKeeeper did help employees, some businesses did not actually need it, but got it anyway.  Now it is ‘moral issue’ that they give it back- that is to say it is voluntary.  If they have already taken it as executive bonuses or shareholder dividends it is probably not refundable.

The welfare recipients who had spent money and were accused retrospectively of Robodebt could not repay it either, but were hounded till the end.  All that will happen to the big end of town is a few days of newspaper articles.   

It is surely a reasonable principle that if taxpayers’ money is given away there should be monitoring of where it goes. If it was too hard to set up a monitoring system quickly, the obvious solution would be to make a regulation that it had to be used for purpose and would be checked and there would be prosecutions if it were misused. This would have allowed follow up, a few prosecutions and majority compliance.  This government seems incapable of any sensible management of anything, unless you think that deliberately handing money to mates is an unwritten policy.

Now even small businesses are annoyed.

www.smh.com.au/politics/federal/pretty-close-to-theft-small-business-slams-big-corporate-jobkeeper-profits-20210304-p577sn.html

Continue Reading

Police Leaving the Police On Medical Grounds Triples- Why?

7 February 2021

We might ask why NSW Police leaving the force on medical grounds has increased from 150 a year in 2014-15 to 420 in 2019-20, almost triple.

There is talk of a culture of bullying.

We might ask what they are being asked to do. Public perception seems to have changed when the changed their name from ‘Police Service’ to ‘Police Force’. The perception that they are now revenue raising, and that their cameras are so that they cannot use their discretion as they themselves are being watched may have contributed to this.

My own view is that the ever-more invasive laws that they are expected to enforce tends to have this result as they are more often thrown into conflict with ordinary citizens who they thought that they were there to help.

www.smh.com.au/national/nsw/fish-swimming-amongst-sharks-why-so-many-police-are-quitting-the-force-20210202-p56yp6.html

Continue Reading

US Health System and COVID-19 11/12/20

Here is an article about the US Health system and its response to COVID. Basically it seems that the US government is subsidising COVID treatments so that they are more lucrative than treatment of other diseases, so the private operators are filling their hospitals with COVID patients whether they need to be admitted or not, and non-COVID patients are excluded.

The other thing that is interesting is that there has been a huge growth in administrators since the 1970s. It has to be understood why private health systems are so inefficient. They have to keep individual insurance databases to keep track of premiums and churn as people change funds. When someone is treated they have to account for every band aid, visit, procedure or investigation, bill the patient and pay the practitioner. They have to market their product, compete for staff, and then figure out ways to avoid paying if possible.

Universal systems have everyone eligible, so do not need to worry about who is getting treated. No need to market the system, maintain many different churning databases, compete for doctors, keep accounts for every details of every treatment and bill and pay for them individually.

In terms of better health care there is no problem of adapting to whatever disease needs the most attention as the staff are motivated to do the most effective treatments, and there is no distortion of priorities to maximise profits.

The US health system is the least effective in the developed world in terms of delivering health care. but it is the most effective at its primary object- turning sickness into money.

No one has looked too closely at why the Australian system has been able to respond. Basically our public health system is State-based hospitals, which are still largely public and have doctors who could be re-directed to testing and vaccination. They can also change to do COVID if needed, and treat disease on their merit.

The private hospitals did very well out of the government subsidies here because they were emptied ready for a COVID influx that never came and they just pocketed the cash without much publicity for this from either themselves or the Government.

Australia has continued on its previous course, which is to starve Medicare and help the private system move towards a US system by stealth, and the COVID pandemic has so far not brought this to light. What is left of the public system has done well, helped by the fact that we are an island nation, so had some warning and could act to quarantine ourselves. The government was happy to take advice from the medical professionals because it had made such a mess of not taking advice from the firefighting professionals. But Medicare is still being quietly destroyed and we are moving to a US system of private medicine.

The government saves money on Medicare doing this, even though the system is much less efficient and much less equitable. But the key reason is not the savings on Medicare, it is the money to the Party coffers from the Private Health Industry (PHI), which is now much stronger with the changes John Howard did to the Aged Care system in 1997, which made it effectively a for-profit system, and the NDIS also a for-profit system, subsidised by the taxpayer through the Medicare levee, which was ironically not being used for health. (The discussion of the Aged Care system was in one of my posts last week).

The key thing to understand in the destruction of Medicare is that the rebate to doctors which was set at 85% of the AMA fee, so as to replace private medicine, has risen at half the inflation rate for 35 years and is now 46% of the AMA rate. Doctors are paid half what they were, so specialists mostly will not use it, and GPs who still bulk bill just do shorter visits.

Here is the article on the US response to COVID. Their prevention is also hopeless, as with such a poor welfare system the people cannot afford to stop work, and the story that it was a hoax was also promoted by President Trump. The obsession with ‘individual rights’ sits uneasily with the idea of staying home for the common good, and makes disinformation campaigns easier. People wanted to believe it was a hoax, because they could not afford to stop work anyway.

http://www.informationclearinghouse.info/55999.htm

Continue Reading

Workers Compensation in NSW and Victoria- ‘Immoral and Unethical’ – 4 Corners Exposes It. 28/7/20

This is what I have been saying for years. If you think the banks are bad, you have not dealt with insurers. They will do anything rather than pay people’s legitimate medical and living expenses.

My poor patients literally starve. They change their addresses each visit as they couch-surf their friends. The foreign patients with no Medicare cannot even get GP treatment, and because they are often paid sub-award wages in cash cannot even prove their incomes. Most specialists simply will not operate for the Medicare rebate, and even if they will the waiting time is a year. I tell the patients where the soup kitchens are. They are in huge pain and the most I hear from governments are warnings that they have been on narcotics too long, as they wait for the surgery that the insurers have refused to pay for.

The patient Scott with his supportive wife, at the beginning of the 27/7/20 4 Corners tells the story of his shattered life, which is just like what my patients tell me.

The Victorian the Ombudsman, Deborah Glass did an investigation into WorkSafe Victoria, the callous government insurer there. She found appalling behaviour and says so very clearly.

In NSW it is the same- the appalling, hopeless iCare, who should be called ‘I Don ‘t Care’ put together a bunch of insurance executives who had no experience in working with people. They all got awarded huge salaries and set about having computer algorithms to replace claims clerks. So when a claim goes wrong (which takes a while to figure out as 3 week delays are pretty much the norm), you call and ask to speak to the case manager. You can’t. But if you persist eventually you find one, but he or she only got the claim yesterday. i.e. There had been no person managing it until you hassled like hell, and it is often refused anyway.

Meanwhile the patient had no treatment and the fat cats at the top had not noticed that their system had a few glitches. And most of the concern in both the management echelons and the media is about some financial deficit which, if we are to believe the totally out-of- touch iCare CEO, Ken Nagle, depends how you do the accounting.

No one seems to remember that this is just a health insurance scheme to help Workers’ Compensation and Motor Vehicle accident Victims. If Medicare worked it would be completely unnecessary, and it cannot even manage to function like a private health insurer. It assumes that all doctors are crooks who cannot be trusted to order just the tests and operations necessary- they all have to be evaluated and denied by insurers who get every dollar that they refuse to pay, and who seek out dodgy doctors to carry out ‘Independent Medical Examinations’ (IMEs) to deny normal treatments. If the IME doctors do not do what the insurers want they get no more work from them.

The directors and top executives of iCare should be sacked and the whole thing given to ICAC to examine. ICAC needs more resources also.

SIRA (State Insurance Regulatory Authority) has been more hopeless than ASIC and APRA were with the banks, and should be abolished also. This story came from a whistle-blower, not from SIRA, the responsible agency, though some of us have been trying to get SIRA to act for years.

SIRA became a bit more interested after the Hayne Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry reported in February 2019, presumably as they realised that if the Commission has been given enough time to look at insurance, they would have had their own hopeless regulatory efforts scrutinised. They had an internal investigation, the Dore Inquiry (no, you almost certainly have not heard of it), but it did actually find that iCare was behaving appallingly. The report release was delayed 5 months (July-December 2019) and released just before Christmas with iCare’s reaction, which was to admit that they had made ‘mistakes’ and that they accepted all the recommendations. Great PR! Released on a busy day to avoid scrutiny and if you as a journo were a tiny bit interested, there was no story because iCare accepted the changes suggested. The SIRA strategy worked- no scrutiny of either iCare or SIRA.

At last there is a 4 Corners on this! Watch it if you missed it!

Let us hope that when it goes to ICAC some major changes are achieved. It seems that 4 Corners is the only regulatory force in the country. I guess that is why the government wants to de-fund the ABC.

https://youtu.be/fxIvKogrE2Q

Continue Reading

Domestic Violence Becomes a Workers Comp Issue 8/6/20

The NSW Supreme Court has held that the children of a worker killed at home by her mentally ill partner in a domestic violence incident can have compensation.

It is good that the issue of domestic violence gets publicity and that the children get compensation. But it raises the issue of whether employers are seriously able to assess the domestic situation of all employees and then whether they can ever hope to intervene in them.  Employers ran a long campaign not to have to pay for journey accidents, people injured on the way to work, on the basis that it was not a risk that they could control, yet which potentially might cause a big change in their insurance premiums and thus costs.  If we want our employers to be concentrating on making their businesses efficient and looking for hazards in the workplaces that they do control, it is slightly dubious public policy to have them sniffing around about employees’ home life.  This case is slightly unusual in that the employer was effectively a partnership bet ween the couple rather than having a distant employer, and the company had been deregistered which suggests some dysfunction  But the money accessed was Workers Compensation insurance and this will affect premiums and potentially other work situations.

It is true that a lot needs to be done about the discovery and action on domestic violence.  It is also true that mentally ill people need to live somewhere and that their carers are at risk.  Judges faced with people in dire need of help such as the children in this situation search for answers, and the Workers Compensation insurance scheme is a source of such funds. But the precedent set is not a good one.

The same principle applies when a baby gets into trouble at birth and has long-term adverse effects. If the obstetrician is found to have erred, there is a lot of money to give the unfortunate infant.  If he or she is not found to have erred, there is no money for the infant.  So now the premiums for obstetricians are very high and some retire in consequence.  4 Corners ran a show on this issue some time ago and it turned out that one doctor was responsible for about 60% of the problem births in Western Australia and had declined to speak to the show. Wow- go after him!  Who was he?  The Professor at the biggest teaching hospital of course.  Most of the difficult cases in the State were admitted under his name, and the staff of the hospital did their best with these cases. 

What is needed is a compensation system that is no fault.  Sometimes bad things happen.  Sometimes people make mistakes. Sometimes big mistakes have small consequences and sometimes little mistakes have big consequences.  With systems, it is not usually one person who makes a mistake, there are miscommunications, lack of clarity who was responsible, lack of availability of something or someone.  Accident causation theory is now an academic discipline, but the legal profession has not really caught up, let alone the political system.

A lot needs to be done about domestic violence, but I am not sure that making it a workers compensation issue will do anything more than push it into the public eye and help these children.  Employers and insurers will run a successful political campaign to change the law to exclude it.  I am not often on the side of Workers Compensation insurers, but a better solution has to be found.

www.smh.com.au/business/workplace/no-longer-a-private-matter-employer-held-responsible-for-family-violence-20200605-p54zy1.html

Continue Reading

COVID-19 Non-Treatment, American Style Points to the Need to Fix Medicare

10 May 2020 As Australian political parties slowly and steadily dismantle Medicare to move us towards a privatised system American-style, it is worth noting the major feature of the American system. Everyone says it is a hopeless system. It depends what you want it to do. It is the world’s best system at turning sickness […]

Continue Reading