Monday, February 20, 2006


From a reader with a memory

The interesting thing about all the reductions in beds in Qld Health now seems to be a flawed "modelling." If you believe that then I have parking spaces to sell on Sydney Harbour Bridge and Ocean Front Land at the base of Uluru. Two things intrigue me. Why can't the Australian Public have the names of these "modelers?" If we had them we might not be so confident that the same people can get it right this time. If they are not the same people who are they? Are they clinicians -- almost certainly not. The unfortunate truth of Medical Administrators are that they are failed clinicians (at least it keeps them away from the patients) or non-clinicians whose backgrounds are quite suspect.

Queensland two decades ago had an enviable health system [Under a long-term conservative State government]. Now it runs close to a third world country standard. Bundaberg, Caboolture and Patel are merely symptoms of a very sick system created by a "model" (for model read delusion) that we can budget-drive hospitals rather than needs-drive them. Awful language but there you are. Of course we need to have a good eye on budgets but they should be the driving force. With an increasing population in Queensland there should be more beds not fewer. Not really rocket science is it? And if you think that Bundaberg and Caboolture hospitals are bad, just wait for the exposures to come. Unfortunately many of those who could expose the problems are either dead or in the "shut yo mouth" group. Fradulent waiting lists, surgery lists not allowed to proceed even when the surgeons were willing to work on (they were sent to libraries and paid to do nothing), outspoken critics muzzled and threatened, (even the Forster report was flawed as the people "assisting the inquiry" were in some cases the worst bullies in the system), a rise of manager numbers coinciding with a fall in real clinicians (remember a lot of so called clinicians are not hands on clinicians -- which has never come out), the increasing scourge of excessive documentation and reduction in care/ treatment giving, and so on. The bus is moving but without drivers. In all good remedies it is important to realize that the incumbents were and are part of the problem. They will merely change the decor and documentation. They have no real will to work or practice medicine.

Now to medical graduate numbers. Even with the figures looking bad you must remember that now medical school intakes have 50% plus female graduates. There is nothing wrong with female medicos IF they practice full time. Many don't - quite apart from maternity leave many choose now to work 2-3 days a week and even restricted hours at that. Of course they have that right BUT medical graduates are expensive for the community to train, unlike lawyers and other courses who simply need a barn, a few talking heads, and access to the internet (why we don't even need a good Law Library these days - just access to the internet). As to the problem of country needs and medicos, it could be solved simply by giving a 3x factor to medicare rebates for remote areas and defined areas of need and reducing the benefits to urban medicos. I can hear the howls of "unfair and conscription" already.

Universal Insurance Mandate Leads to Political Interference in Private Health-Care Decisions

Republican Governor Mitt Romney is proposing that all citizens of Massachusetts be required to purchase health insurance, join a government-subsidized program, or face a financial penalty. His plan is being touted as a free-market alternative to proposals being pushed by advocates of single-payer health care. Its compulsory feature is similar, in some ways, to the mandate proposed by congressional Republicans after the Clinton administration called for universal coverage in the fall of 1993. What's wrong with the government mandating individuals to purchase health insurance?

The Cato Institute analyzed the Republican's 1993 plan and pointed out why a mandate is dangerous to liberty. Following are excerpts from that Cato Policy Analysis:

* "Once we presume that government is ultimately responsible for guaranteeing that every American has health insurance, we also guarantee a permanent role for politicians in determining an accompanying set of issues. Once government mandates insurance coverage, it must define what constitutes `adequate' insurance coverage for each citizen."

* "By endorsing the concept of compulsory universal insurance coverage, [the bill] undermines the traditional principles of personal liberty and individual responsibility that provide essential bulwarks against all-intrusive governmental control of health care."

* ".[The bill] makes the fatal mistake of endorsing compulsory, government-defined, universal insurance coverage. That fundamental feature...opens the door wide to extensive political interference in private health care decisions."

* "Sweeping every American into a mandatory health insurance dragnet is not only offensive on philosophical grounds; it is also impossible to achieve.... Even under Canada's system of national health insurance, an estimated 2 to 5 percent of the population in the province of British Columbia is uninsured. Despite 41 state laws that require motorists to purchase automobile liability insurance, one in seven automobile drivers remains uninsured."

* "It is also rather difficult to enforce mandates on people who fall between the cracks of government databases. Not even heavy reliance on tax penalties can overcome the Internal Revenue Service's inability to track down millions of Americans who refuse, or fail, to file tax returns. And every 10 years the Census Bureau demonstrates that it cannot locate several million citizens."

* "Thus, one can expect that any...enforcement offensive to coerce the voluntarily uninsured into signing up for a mandatory coverage scheme will become both prohibitively onerous and politically pointless at the margin."

* "When those costs are added to the havoc that further political control of the entire health care market would wreak, even subsidizing the full amount of uncompensated care with public funds looks like a better buy for American society."

Of course, this is not to say that a single-payer system for the uninsured would be better than mandated insurance. As noted in an article titled "Universal Health Care Won't Work-Witness Medicare," (written by Sue Blevins and published by Cato in 2003):

* "At first glance, many Americans might find the idea of single-payer health insurance appealing, given current economic conditions and high health insurance costs. However, before we accept such a drastic shift in national health policy, we should examine how single-payer health insurance could affect all individuals' health care costs, choices and privacy."

* "If history is any indication, any single-payer initiative will end up costing much more than advocates claim. That, in turn, will lead to higher taxes and/or rationing under which the government will determine which medical treatments will and will not be covered. How do we know this will happen? Because single-payer health care has already been empirically tested on seniors in the United States."

Medicare is the largest single payer of health care in the United States and the world. Thus, for Americans to understand how a compulsory program would affect them, they need only look to Medicare to see its impact on individual freedom. They can see clearly how a universal mandate for health insurance leads to political interference in private health-care decisions for all.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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