Doctor and activist

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Category: Accountability

CTP Facebook Article- The Facts 11/9/16

CTP, Compulsory Third Party insurance (Green Slips) is an area where I work. In theory, if you are injured in an accident that is not your fault, all your treatment is currently paid for by your insurer. The law says that they must pay for ‘reasonable and necessary’ treatment, which I assume to mean the treatment that would happen in good routine medical practice. Wrong.

The insurers have 3 months to decide if they are liable for the accident. If they decide they are not they will not pay. If they decide that they will pay, all treatment decisions have to be referred to them as to whether they will pay or not, and sometimes, despite MRI scans, severe symptoms and a neurosurgeon saying that their life is at risk, they will not pay. I have a number of patients who have waited over a year in agony for treatments that are both reasonable and necessary but the insurers will not pay for. They say that the patients can get it themselves if they like (obviously if they can afford it), of they can get it on Medicare (if they have Medicare and if they can find a surgeon who will operate on Medicare for a third of the money that should be paid by the insurer. Such surgeons cannot be found).

The protocol for disputes vary slightly between insurers. For example, the NRMA protocol is that you can firstly approach the claims clerk who rejected it and ask him/her to change their mind. Secondly you can appeal to their team leader. Thirdly you can appeal to the NRMA Senior Claims Manager. Fourthly you can appeal to the government appointed Medical Assessment Service (MAS), which guarantees to assess the disputed issue and rule within 3 months! Or the treating doctor can try to find a Medicare surgeon, send them to a public hospital, or write yet another prescription for pain killers. (Mostly the insurers pay for pain killers, though they do argue over some other drugs). Many GPs have simply given up treating CTP patients.

All these delays, frequently running into months can be compared to the doctors and nurses in Emergency Departments of public hospitals who have to write long explanations for the Health Minister if patients wait more than 4 hours in the Emergency Departments. So if you think private medicine is better than public- think again. We are going the way of the US. Insurers control it all.

Patients are assesses by an iniquitous system devised by American Insurance companies in cooperation, (inexplicably enough) with the American Medical Association. This has resulted in a tome, the ‘AMA Guidelines for the Assessment of Permanent Impairment’ which supposedly gives a percentage of impairment of your body, so that injured people can get compensation based on the percentage impairment that they have. Doctors can do a course in how to use this guidebook and then do lucrative medicals based on it. The reason the book was produced was to lessen litigation on how injured someone was, which would save legal costs. As pain cannot be measured, this was left out, which is just the first reason why the book is a farce. Since pain is the main thing that stops people working, to talk of impairment without considering pain is almost like having a swimming race without water- just not quite. Secondly despite the tome’s carefully crafted descriptions, doctors assessment using the guidelines vary widely. Thirdly, it is very hard to get over 10% impairment, which is the amount Mr Baird’s reforms intend to define as more than a ‘minor injury’ so there will be many people with only a few percent impairment, and thus minimal compensation, who will be unemployed and unemployable. Fourthly, the guides only talk of ‘impairment’. Any one who works in disability knows that there is quite a difference between an impairment and a disability. For example if someone is very shortsighted they are impaired, but if they have good prescription glasses they may not be disabled by that impairment. People who work with their brains are similarly less disabled than those who need their physical strength, but have the same impairment. So physical workers are again disadvantaged.
The new scheme will cut out lawyers and advocacy, and will give a statutory small amount to ‘minor’ injuries. The insurers will dump long term patients on the welfare system and continue to get a lot of money for doing not much that is useful.

I would finish by saying that I think the whole system is appalling and that the way to solve the health system problem is to raise the Medicare rebate from 48% of the AMA fee to 85%, where it was when it started, and there would be no trouble getting doctors to treat the patients who needed it. There also needs to be a single insurer, so that disputes between insurers will not delay treatment, which they frequently do, and everyone should be covered, even ‘at fault’ drivers, who still need treating despite their error.

For the present six insurers, all are bad, but they are not all as bad as each other. There are no published figures to compare them rationally, but based on personal experience, I have just changed my insurance from NRMA to GIO. The TV ad about feeling ‘confident’ about your insurer is a bad joke.
Wish me luck, as I wish you.
Here is an SMH article by Anna Patty 12/9/16 which raises the issues in a somewhat understated way.

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My second Obeid story. 29/6/16

I was in NSW Parliament and an old school friend wanted to meet for old times, so we went down to the coffee shop at Sydney Hospital.  As we went in Grahame Richardson and Eddie Obeid were talking together. As we walked past Richo was facing me, Eddie had his back to us. I nodded at Richo and went past.  My friend and I had rather a long chat, but as we came back, Richo and Eddie were still there.  I nodded at Eddie.  Richo, (who is a very sociable guy whatever else he may be) said, ‘Hello Arthur’.  I was a bit surprised he even knew my name, but he is good at that sort of thing. I stopped, turned round and replied, ‘Hi Richo’.  Then a sense of devilment took me and I added, ‘What are you going to do about Beasley?’  Beasley was ALP leader at that time and was not doing very well in the polls, and some people wondered when he would be replaced.

‘We are going to replace him’ said Richo.

‘And who with? I asked.  (No harm in asking).

‘Rudd’, said Richo.

‘He’s not much chop is he? Bit of a Bible botherer?’ I replied.

‘Best we’ve got at the moment’, said Richo.

‘That may be,’ I said and toddled off.

Seven months later Rudd replaced Beasley, and the rest is history.

Richo is not a man to stab you in the back- he stabs in the front, presumably smiling and telling you it needs to be done.  Eddie was the NSW numbers man, which is why no one moved against him.  Carr and Egan kept him out of the ministry, but when Carr went, he came in. Things went bad, and eventually when things were very bad, compromise Premier Nathan Rees tried to clean up the NSW Labor party, and drop Tripodi, a mate of Eddie’s. He failed and was then thrown out.  Kristina Keneally became Premier, just before the election with a good new female image, but of course NSW Labor was not fixable or saleable by then, and Barry O’Farrell won in a landslide, only to lose office due to forgetting that he received a bottle of Penfold’s Grange Hermitage from the property developer today said to have called on Eddie.

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Eddie Obeid. My First Story. 28/6/16

When I first got into Parliament in 1998 Eddie offered me a lift to Parliament.  I accepted. It seemed harmless enough. He had a car with a driver and lived not far from me.  Then he offered to give me some advice about how to get on in Parliament. 

I said, ‘Fine, Go ahead’. There was no harm in listening.

He said, ‘Arthur you are in a very little party, but if you vote with the (then Labor) government, we will give you a little win just before the election and you will be re-elected’.

I said, ‘Well, Eddie, you might think we are a little party, but we have a lot of policies that are important and if you help those policies, I will vote for you and if you don’t I will vote against you. That is my job”. 

He said, ‘No Arthur, you do not understand, we are the government’. 

I said, ‘That does not really impress me, my job is to change the government’. 

He gave me a lift the next 2 times and we had virtually the same conversation. He would say, ‘Arthur, you are not really understanding,’ (meaning I was not voting the way he wanted).  ‘You are a very small party and we are the government and if you vote with us, just before the election we will give you a little win etc’..   So  on the 3rd recitation of this I wondered what a ‘little win’ might be. I had got into politics campaigning against tobacco and I knew that what was needed to save a lot of lives was smoke-free air everywhere, especially in the pubs and clubs that were the bastions of smoking, and a big health campaign against tobacco. ‘So I said, ‘Well, what I came onto parliament for was to fix the tobacco problem, you could fix that at no cost. It is just a ban, and the health campaign would pay for itself in hospital costs almost immediately.  That could be the ‘little win’ you talked about’. 

He said, ‘That is a very big thing. We could never do that’. I said, ‘Well I guess its no deal then’. He turned up the radio and we sat without talking as Ray Hadley rabbited on. 

I did not get a lift in the mornings, but I kept getting a lift with him for some time in the evenings when we finished late.  He was quite friendly and I used to meet him in his office. But one day he said to me, ‘Arthur I give you a lift home and you do not vote for us.’  There was no answer to this.  Could anyone think that a lift home should change a vote in Parliament?  Eddie obviously did.  I figured there were some people who did nothing for nothing.  After that I took a taxi voucher.  The taxpayer had to cop the extra price of an independent mind in Parliament.

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Using the COVID19 Crisis for Bad 29/5/20

Some years ago, my attention was drawn to a 2007 book, ‘The Shock Doctrine: The Rise of Disaster Capitalism’ by the Canadian author and social activist Naomi Klein. The idea was that if a coastal community was blown away, say by a Tsunami with a loss of owners, records etc, some coastal land could be […]

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Medicare- Did the Liberals try to abolish it?

21 June 2016 This is a current question with Shorten claiming that the Liberals are trying to privatise it and Turnbull calling this a Labor lie. What is the truth?  The answer is in the history of Medicare funding.  Medibank was set up by the Whitlam government and the bulk billing frees were set at […]

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Medicare- Did the Liberals try to abolish it? 21/6/16

This is a current question with Shorten claiming that the Liberals are trying to privatise it and Turnbull calling this a Labor lie. What is the truth? 

The answer is in the history of Medicare funding.  Medibank was set up by the Whitlam government and the bulk billing frees were set at 85% of the AMA ‘Most Common Fee’. The 15% was a discount but saved doctors a lot of costs and all their bad debts. They got slightly less, but the clerical and hassles saved by simply sending the paperwork, and later the computer message to the Medicare computer was felt to be a good deal.  But ever since then both major parties have not raised the Medicare same rate as inflation, in fact at about half the inflation rate.  This has resulted in the Medicare rebate being about half the AMA fees.  Specialists often will not see patients on Medicare unless they have a Health Care card, and GP practices simply cannot survive if all their patients are bulk billed.  GP practices have survived by having pathology companies rent a room where they collect bloods for a relatively high price. This has allowed the government to keep the GP Medicate rebates low. Recently the government tried to change the pathology rebates, and the companies resisted, but the treat was that the pathology companies would stop subsidising GP rental and a whole fuss would have erupted re the uneconomic nature of General Practice.  The government did not want this just before an election, so the pathology system was left as is.  But can we trust the Turnbull government? I don’t think so. A couple of other pointers:

The Emergency Departments (EDs) have recently been in the news as having a hugely increased workload and there was a request for funds, also recently seen as a question to Turnbull on Q&A.   EDs get busier if people do not go to GPs, who are far cheaper, and generally pick up problems earlier than EDs.  So the rise in ED use is likely to be a reflection of the lack of funding of GPs by Medicare.

There have been a lot of rather convoluted plans to deal with chronic illness. As the population ages, and as it gets problems with obesity and diabetes, there are more visits, more prevention is needed.  GPs are the cheapest medical intervention, so one might have expected that they would be the key element in the strategy to deal with it, perhaps supplemented by practice nurses or other slightly cheaper options based around GP-type community health centres.  But instead of this there was a bemoaning of the difficulties and lot of convoluted nonsense trying to avoid raising GP payments to a viable level.  It looked very like the object was not to find a solution to the problem, so that Private Heath insurers and the profit sector could get a look in at the problem and start to make some money.

Now we hear that there has been $5 million to look at outsourcing, just the payments part of Medicare.  Well Medicare is Just a payments system, so that is the guts of it. 

So it is very likely that the Libs want to privatise Medicare and take us to a US model of the health care. The public do not want this, but big business does, a powerful lobby in Canberra does, party political donors do, and the government can lessen the  amount it pays for health, even though the total cost will rise dramatically.

Labor also has historically a very bad record. They have allowed the Medicare rebate to fall with inflation, had a rebate ‘freeze’ of their own, and their only promise is to stop the freeze, which still leaves most doctors either unwilling in the case of specialists or unable in the case of GPs, to survive.

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House of Welcome is a group that helps refugees.

19 June 2016

The House of Welcome had a fundraising dinner in North Sydney Community Centre tonight that I attended. Great food cooked by refugees in a variety of national recipes, with folk singing and dancing.

The House of Welcome started from people who were visiting detainees at Villawood Detention Centre and then became aware that they were being let out the gate with $10 and no benefits.  The continuing support evolved and they now have 26 properties and 96 people housed.  They feed a lot of people, trying to get food banks food with mainly ingredients so that the refugees can cook themselves.  They also help with CVs to get jobs and setting up small businesses selling crafts or food at fairs, or home careering for entertainment.

North Sydney Community Centre staff came in and helped free, and have done so for some years.  It is great and gutsy stuff, but I could not help thinking that in the 1950s, Australia took hundreds of thousands of post-war refugees and had programmes for them.  Now we have expensive deterrence programmes, and the arrivals have no welfare or Medicare.  The House of Welcome is doing a great job- I just wonder why the government is doing so little.  Australia should do better.

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