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Category: Insurance

21/07/2024

DVA Still Screwing Veterans

21 July 2021

A recent article shows that the Dept of Veteran Affairs is still making it hard for injured veterans to get redress.

This is entirely consistent with the way that governments try to minimise all welfare payments.

Centrelink is a bureaucratic nightmare. They will not pay until you have absolutely no resources, and the amounts are not enough even to pay rent in capital cities. Morrison claimed that he had cut the rate of people being granted the Disability Support Pension by two thirds. All the people refused have to keep sending off job applications as part of their ‘mutual obligations’. I see these people. They have virtually no hope of a job and are wasting their own and employers’ time.

I work in the State area of workers compensation and CTP injury. SIRA (State Insurance Regulatory Agency) is chiefly concerned that insurers do not pay out too much, so that the government can boast that premiums are low. There’s not much danger of insurers overpaying. They refuse a large number of investigations and treatments that are standard elsewhere.

Veterans Affairs used to be a special welfare system for returned service personnel and was set up after the world wars as a system to look after heroes. But wars lately have been neither popular, nor in Australia’s interest. The Vietnam war was unpopular, as were the wars in Iraq and Afghanistan. Vietnam was a mistake, but the more recent ones were merely done to please the USA, who also should not have been there. Our troops have lots of PTSD and because negative media coverage was stopped after Vietnam, the veterans cannot really talk about what happened to anyone who understands. Their suicide rate has been high. But consistent with the lack of willingness for any sort of welfare, the veterans also have a bureaucratic nightmare, which delays payment as long as possible, often till their death by suicide.

The market-obsessed late capitalist system in which we live simply creates greater inequality, and the only way to maintain a harmonious social fabric will be to support disadvantaged people, whatever the cause of their disadvantage. It has been said that the Left tries to lessen inequality and the populist Right tries to defend privilege or finds scapegoats. As we watch the US unravel or see our government and opposition blame migrants for the housing shortage it is hard to argue with this proposition.

In the meantime, the veterans need help against the government’s lawyers. And the population should try to stop us being drawn into very silly wars. Taiwan looks like the next danger.

Royal Commission into Veteran Suicide confronts lawfare, cronyism and a bureaucratic nightmare

16/02/2024

‘Health Policy’

Chesterfield-Evans, A. (2024)

Journal of Australian Political Economy No. 92, pp. 98-105.

HEALTH POLICY
Arthur Chesterfield-Evans

Just before the 2022 federal election, Mark Butler, now the Minister for
Health in the Albanese government, spoke to the National Press Club,
praising the courage of the Hawke government in creating Medicare in
1984. His speech also set modest priorities for a prospective Labor
government, committing to (1) improve the digital health record and make
the MyHealth record actually useful; (2) develop multidisciplinary care;
(3) establish a new funding model for ‘MyMedicare’; and (4) grow the
medical workforce, with special mention of nurses and pharmacists (Butler
2022). Significantly, Butler did not commit afresh to Medicare as a
universal health scheme free at the point of delivery, the key element of
the original 1984 scheme that he praised. In an environment where,
politically, it seems that taxes cannot be increased, perhaps this ideal may
be an impossibility, but it is surely significant that it is no longer stated as
an aspiration.
Currently, Medicare is quietly dying as the low rebates cause doctors to
abandon it. Australia is moving to a US-type private system by
default. This has resulted in large amounts of hand-wringing rhetoric, but
so far little action. This short article comments on the changes initiated by
the current Labor government during its first year and a half, contrasting
these with the deep-seated problems needing to be addressed if better
health outcomes are to be achieved.
Labor’s reforms
The government has made some minor changes to Medicare which came
in with great fanfare on November 1, 2023. There were new item numbers

for new specialist technologies or treatments and an increased Medicare
rebate for GPs, up to $41.40 for a standard visit for a RACGP member,
which is 40.6% of the AMA fee. Doctors without the RACGP qualification
still get $21, which is 20.6% of the $102 AMA fee.
When Medicare was born, the Medicare rebate was 85% of the AMA fee.
The rebate has risen at half the inflation rate for 39 years, so doctors now
feel ripped off every time they see a Medicare patient. Labor blames the
disparity on the rebate freezes of the previous LNP Coalition governments,
but its own record is poor. Successive governments of all types have
deferred to the private health lobby and are starving Medicare, slowly
defaulting towards a principally private system, as in the USA. This is a
deeply-troubling prospect because the US health system has been
recurrently criticised (Commonwealth Fund 2021) – and rightly so –
because it makes access to health care dependent on ability to pay. Notably,
however, it is the world’s best system at turning sickness into money.
The other recent Labor ‘reform’ was to allow pharmacists to process
prescribed medications to cover patients’ requirements for 60 days, rather
than 30 days, thereby halving the costs of prescribing and dispensing.
While this may seem helpful, patients are often confused by complicated
generic names and generic brands; and compliance or discontinuation of
medicines is a largely unquantified problem. These are existing problems
with the current arrangements for dispensing medications: the recent
policy change, while well-intentioned, does not redress them. It transfers
resources from professional staff to the pharmaceutical industry.
The ‘Strengthening Medicare Taskforce’ had good medical and allied
health representatives and support. Its December 2022 report defined the
problems but, trying to avoid controversy, positive suggestions were thin
on the ground. A deeper analysis and more comprehensive approach to the
redress of health issues is needed.
Basic problems in the health system
Diverse funding sources causes cost-shifting
Fundamentally, no-one is in overall control of the health system. It has a
number of different funding sources: the Federal and State governments,
the Private Health Insurance industry (PHI), Medicare and individuals

themselves. Workers Compensation (WC) and Compulsory Third Party
(CTP) insurers also put in a bit. These arrangements lead to a situation
where each funding entity attempts to shift costs without any real care for
the overall cost of the system. Private entities such as pathology and
radiology also have an interest in providing more services, whether they
are needed or not.
The broad division of the health system is that public hospitals and
emergency departments (EDs) are State-funded, and non-hospital services
are Federally, PHI or self (patient) funded. There is some overlap,
however, because the State’s provision of some community-based services
allows them to save on hospital-bed days; and private funds paid to State
hospital in-patients are eagerly sought. The starvation of Medicare (which
reduces the Federal government’s spending) has resulted in more patients
going to EDs at higher (State) cost, as well as increasing PHI and patient
costs.
This cost-shifting has evident implications for the affordability of health
care: notably, a recent study showed that Australia, when compared to 10
other countries, scored poorly on its measure of affordability
(Commonwealth Fund 2021).

A new health paradigm is needed
Yet more fundamentally, there is a huge problem with the conceptual
model of the health system. In common parlance, the ‘health system’ is the
‘paying to treat illness’ system. Paying doctors to see and treat patients is
seen as the major cost and is the most politically fraught element in the
system.
Historically, everyone was assumed to be healthy and had episodes of
either infectious diseases or surgical problems. They went into a hospital
for a brief period and either recovered or died. The legacy of this is that
heroic interventions are over-resourced and the more cost-effective early
interventions are under-resourced.
Infectious disease is now relatively uncommon, notwithstanding the recent
and ongoing coronavirus concerns. Most disease is chronic; and the
objective is to maintain health for as long as possible and to support those
who need support in the community rather than in institutions. ‘Health’
must be re-defined as a state of physical and mental wellbeing; and
maintaining it as ‘demand management’ for the treatment system.

Life-style diseases of diet, obesity, smoking, vaping, alcohol, drug-use and
lack of exercise need attention. It might be commented that these habits
are more determined by the political economy of the products than by any
health considerations; and the government should intervene to re-balance
this market failure.

Hierarchies, cartels and corporatisation
The medical system is hierarchical with specialists at the top and GPs at
the bottom. The specialist colleges have produced less practitioners than
would have been optimal. The starvation of General Practice has led to
increasing specialist referrals for simple procedures. Most patients are
happy to go along with this, though often much less happy about the rising
costs. Practitioners tend to work down to their station rather than up to
their capacity. GPs, if given the appropriate additional education and
empowered to act, could do what quite a lot of specialists do now, while
nurses could take the load from GPs; and, in terms of home support, a more
comprehensive and flexible workforce needs to be developed.
Private medical insurance systems are a further source of problems. They
have marketing, churn, profits, liability and fraud issues; and they make it
necessary to account for every item of every procedure. While the
corporations watch every cost, the regulator cannot. Corporations buy
medical practices and take up to 55% of the gross revenue. Smaller
radiology practices are being gobbled up as investments (Cranston 2020).
If overheads are defined as the amount of money put in compared to the
amount paid for treatments, Medicare costs about 5% and PHIs, as they
are regulated in Australia, about 12%. In the USA, the private health funds
take up to 35%, and Australia’s CTP system got close to 50%. A universal
health insurance system could avoid many of these costs and would be far
superior from a social equity point of view.
Similar problems are evident in the provision of care for people with
disabilities. Labor pioneered the NDIS when last in office a decade ago,
and rightly claims this as evidence of its commitment to redress the
previous neglect. However, the NDIS can be considered as a privatisation
of the welfare system. It overlaps medical system functions and is poorly
regulated. If its efficiency is judged by the percentage of money put in that
is paid to the actual workers delivering the service, care is not very

efficient. There have also been significant criminal rip-offs (Galloway
2023).
Retirement care arrangements have major flaws too. Aged-care
accommodation is largely driven by the real estate industry; and access to
continuing care is an add-on of often dubious quality.

What should the government do?
The problems described above are diverse, deep-seated and not easily
rectified. However, a government intent on staying in office for a series of
terms could heed the call for some big thinking, drawing on the experience
of health practitioners themselves. Here is a list of what might be done,
becoming more medical and more politically difficult as it progresses:
• Keep people healthy with education, clean water, sanitation, housing,
good food, regular exercise, high vaccination rates, road safety,
universal swimming lessons, CPR and first aid training and the active
discouragement of smoking, vaping, alcohol and drug use, junk food
and gambling.
• Provide housing with graded community support options for those
people with disadvantage or impairment. Create a registration and
insurance system for home and community support services, so that
individuals can buy standardised services from other individuals.
• Maintain fixed staff-patient ratios related to the disability
classification of residents in institutional care.
• Make maximum use of community and school interventions and
support services such as District and Community nurses and School
nurses, mental health support networks, Aged Care Assessment
Teams, Hospitals in the Home etc.
• Address health problems as early and as low down the support and
treatment hierarchy as possible, by empowering those who provide
the services.
• Create a meaningful regulatory, inspection and enforcement system
for support services, both community and residential, and for
workplaces and recreational facilities.
• Use the medical information system to research drug and treatment
effectiveness.

• Support General Practitioners and try to increase their ability to solve
problems without referral. Have GPs work in Health Centres with
community support workers as far as possible; and improve
communication with data collection a by-product of normal work, not
an additional imposition.
• Have independent evaluation of the numbers needed in the specialties
and pressure the colleges to provide these numbers. Use waiting times
as an initial index.
• Initiate either university-based or college-based continuing medical or
professional education, with mandatory refresher exams every
decade.
• Have universal professional indemnity insurance, with doctors and
other health professionals unable to be sued if they report all incidents
of sub-optimal outcomes within 48 hours of becoming aware of them,
and participate in regular quality control meetings.
• Publicise and promote organ donation, end of life plans, wills and
enduring powers of attorney as sensible steps in life-management.
• Evaluate Intensive Care interventions in QALY (Quality-Adjusted
Life Years) terms, researching their outcomes and comparing them to
earlier intervention initiatives.
• Change the composition of the Pharmaceutical Benefits Advisory
Committee so that it has no pharmaceutical industry representative on
it; and remove ministerial discretion from its decisions. The previous
system evaluated new drug listing approvals with a cost-benefit
analysis (Doran et al. 2008), but the Howard reforms of 2007,
following the Australia-US Free Trade Agreement and lobbying by
Pfizer, put a drug industry representative on this committee, making
its negotiations more transparent and thus more difficult for the PBS
to negotiate prices (Access to Medicine Working Group 2007).
• Work towards replacing Workers Compensation and CTP insurance
schemes with income guarantee schemes (this will only be possible
when Medicare allows timely treatment).
• Create a credible and indexed scheme for paying medical
professionals which does not have KPIs that distort performance.

• Make Medicare a universal taxpayer funded health system that is free
at the point of delivery and stop subsidising PHI. It might be noted
that the Government currently quotes Medicare and PHI costs
together as a sum rather than itemising the two, which serves to
disguise the subsidy to PHI (Parliament of Australia 2022).

Conclusion
The current federal Labor government has made statements about health
policy reform and done minor tinkering during the first year and a half in
office. Based on this start, it is doubtful that it will have the courage to
make the necessary major changes, addressing the systemic problems.
Fine rhetoric is unlikely to achieve much. That makes it doubly important
to develop proposals for more fundamental reform. Written with this
intention, the suggestions made in this article could be the basis for
tackling the fundamental institutional and political economic issues
problems associated with personal and societal ill-health.
Dr Arthur Chesterfield-Evans trained as a surgeon in Sydney and the UK
and is a Fellow of the Royal College of Surgeons. He currently works as a
GP with interests in workers’ compensation and third-party injury. He has
been a tobacco activist and an elected member of the upper house of the
NSW Parliament. He has Master’s degrees in Occupational Health and in
Political Economy.
chesterfieldevans@gmail.com

References
Butler, M. (2022) ‘Address to National Press Club, 2 May,’ available:
www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-
care-speech-national-press-club-2-may-2023.
Commonwealth Fund (2021) US Report, available:
www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-
reflecting-poorly.
Cranston, M. (2020) ‘Radiology enjoys a post-virus buying boom’, Australian Financial
Review, available: www.afr.com/policy/economy/radiology-enjoys-a-post-virus-buying-
boom-20201106-p56c7k.

Doran, E., Henry, D., Faunce, T.A. and Searles, A. (2008) ‘Australian pharmaceuticals policy
and the idea of innovation’, Journal of Australian Political Economy, 62, pp. 39-60.
Galloway, A. (2023) ‘Federal crime syndicates using cash vouchers and gifts to steal NDIS
funds’, The Sydney Morning Herald, available: www.smh.com.au/politics/federal/criminal-
syndicates-using-cash-vouchers-and-gifts-to-steal-ndis-funds-20230414-p5d0ma.html.
Parliamentary Library (2022) Health overview, available:
www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/p
ubs/rp/BudgetReview202223/HealthOverview.
PBS (2007) ‘Access to medicines working group’, available: www.pbs.gov.au/info Access to
Medicines /general/working-groups/amwg/amwg-jul-2007.
Sax, S. (1984) A Strife of Interests: Politics and Policies in Australian Health Services,
Sydney: George Allen and Unwin.
Searles, A., Jefferys, S., Doran, E. and Henry D.A. (2007) ‘Reference pricing, generic drugs
and proposed changes to the Pharmaceutical Benefits Scheme’, Medical Journal of Australia,
187(4), pp. 236-39.
Strengthening Medicare Taskforce (2022) Taskforce Report, Commonwealth Department of
Health, available: www.health.gov.au/sites/default/files/2023-02/strengthening-medicare-taskforce-report_0.pdf.

07/12/2023

Hospital Crisis is just part of the story.

6 November 2023

The hospital crisis is partly because General Practice has been so downgraded that more cases go to hospital than need to. The Federal government starving Medicare has a number of consequences:
Many GPs are simply retiring and there are no enough new ones taking their place, so we are getting towards a serious shortage
GPs cannot survive on the Medicare rebate, so now charge a co-payment.
Since Emergency departments are free, people wait until the situation gets worse then go there.
Emergency Depts are about 6 times the cost of GP visits, so the total cost of the Health Care system rises.
The other part of the Federal government starving Medicare is that the State governments pay for the emergency departments, so it is a case of the Federal government saving money by making it a lot more difficult for the States.
But an overriding fact is that Australia has been convinced by the neo-liberals that tax is a bad thing and government spending must be a small percentage of GDP. Currently this is about 38.4% of GDP, slightly less than the USA, which has very poor welfare and health systems. This means that the governments cannot actually afford to do anything, and behave like a corporation, cutting employee wages and making cuts wherever it thinks no one will notice, or it has the power to do so. Now if Labor ever tries to raise taxes, the Liberals, who are great exponents of small government accuse Labor of being ‘tax and spend’, and Labor, rather than have a serious debate merely retreats. The fact that he Scandinavian countries have government as close to half of GDP and have their citizens much better off never gets mentioned. Denmark is at 49.9%, Germany 49%, Finland 54% and France at 54%. The UK is at 45%.
We now have a failing GP sector, a problem in aged care, a shortage of nurses, paramedics on strike, a hollowed out public service that merely awards its former tasks to private sector operators that it cannot even monitor and Australia falling down the World educational standards table is not a coincidence. The governments have a virtual monopoly of these jobs. They have deliberately let wages fall, so that now people simply will not do them.
We need to stop privatising, rebuild that public sector so that it can deliver services that we need. Profit is merely another unnecessary overhead. We need to decide what needs to be done, and raise enough tax to pay the people to stay in their public service jobs. Education, health and aged care do not need a ‘market’ to function/. If one exists for comparison purposes, that is fine, but there is no actual virtue in having most of the services delivered by corporations that have the choice of good service or good profits. It is a con, and it is time we forced the government to give us Medicare and a health system that actually works for all, and education for all.
Here is a letter from my Medical partner in today’s Sydney Morning Herald.

The horror stories now emerging about overloaded public hospitals, ambulances and emergency departments comes as no surprise to anyone following the downgrading of Medicare to a ‘‘mixed billing’’ system. This has made it unaffordable for many people to see a GP. But the real cost of turning Medicare into a two-tier system has been to the public hospital system. The only winners are private corporations, private hospitals, private health insurance funds and their many lobbyists in Canberra. We are going the way of the US, and if people don’t fight for Medicare, we are all doomed.
Con Costa, Hurlstone Park:

Here is today’s Herald Editorial

Health system needs its own emergency care
The state of health of the health system has dominated the lives of Australians for four years, but it has never been in such need of urgent care. Indicative of how working conditions for frontline healthcare workers have deteriorated, people now spend a median of three hours and 36 minutes in NSW hospital emergency departments, the longest wait ever. It’s little wonder that health workers are suffering burnout, stress and bullying and are leaving the industry in record numbers.
The COVID-19 pandemic sharpened awareness of our vulnerabilities and forced extra spending on hospitals, clinical responses, vaccinations and prevention measures.
And when we emerged from the pandemic’s worst days it became evident the health system too was experiencing difficulty recovering from years of stress. It had been deteriorating for a long time already, but post-pandemic we became uncomfortably aware that ambulances were queueing for hours to offload emergency patients and hospitals were under enormous pressure with lengthy wait times in emergency and admission.
GPs bumped up fees, forcing people who could not afford the $11-a-visit hike into hospital emergency departments. The industry is being further destabilised by the exodus of 6500 nurses and midwives a year.
If anything, the situation is worse outside the big cities. Last year, for instance, five deaths in regional hospitals could potentially have been prevented, but not in an overworked hospital system with staff shortages that make mistakes even more likely. The NSW parliament’s health portfolio committee report on rural, regional and remote health 18 months ago found a ‘‘culture of fear’’ which did not encourage or value feedback and complaints. Some workers say they were even punished for making complaints.
Now an investigation by the Herald has revealed a health system sinking further into crisis. Eight nurses and midwives have taken their lives in the past three years, while nearly 2000 NSW Health workers have lodged compensation claims for psychological injuries over the past two years. More than 33,500 NSW Health employees have also claimed they are burnt out, while 21,000 workers say they have witnessed bullying in the workplace. One in 12 ambulance employees hold a compensation claim for a psychological injury.
Experts and unions warn that the data, drawn from documents obtained exclusively under freedom of information laws and the state government’s recently released annual employee survey, People Matter, shows a workplace struggling with staff mental health concerns.
Further illustrating the stress, NSW Ambulance fielded a record 363,251 calls and fired up the lights and sirens for more than 181,000 emergency call-outs between July and September, the most of any three-month period since the Bureau of Health Information began taking records in 2010.
Money seems to be the root cause of health’s problems. Today’s national cabinet meeting will address the rampant cost blowouts in the NDIS and Canberra wants the states to take responsibility for funding treatments. On Friday, Premier Chris Minns and Treasurer Daniel Mookhey meet the Health Services Union over a protracted pay dispute threatening to collapse the NSW triple zero call system on New Year’s Eve. Minns said the money is not available.
The future funding and structure of our health systems concerns us all. It is an area where the federal and state governments share responsibility. The solution to the healthcare crisis is complex and will take time, but it is an area where increased funding must be found.
That clearly calls for a better national approach and the states responding with an end to parochial wheelbarrowpushing and finger-pointing.

04/04/2023

Classification of Impairment

4 April 2023

I was lucky enough in my surgical training years to have most of a year working as neurosurgical registrar for Dr John Grant. He set up the 1st spinal Injuries Unit in Australia saying that while everyone was looking for a miracle cure that would allow injured spinal tissue to repair, most paraplegics were dying of bedsores or infections coming up their urinary catheters and much better practices and training was needed.

He went to England in 1960 and with Sir Ludwig Guttman started the Stoke Mandeville games, the precursor of the Paralympics. He developed the Paralympic Games to help his patients, who were mostly young men whose lives had been shattered after a catastrophic injury, often after doing something daring or unwise. Wheelchair athletics was a major part of this, as it gave the young paraplegic people something to strive for. John Grant became head of the Australian Paralympic movement and Chair of the Organising Committee of the Sydney 2000 Paralympic Games. My part was merely to help treat the spinal patients.

Later I moved into occupational medicine so as to fund my work in the anti-tobacco movement. There I found impairment from workplace injury and had to decide who could work and who could not. This got a nasty edge to it as insurers wanted people classified as fit, so that if they would not work their pay could be suspended. The Courts argued about this until the legal process was deemed so expensive that the American Medical Association worked with the insurance industry to devise a complicated medical examination which measured ‘Whole Body Impairment’ as a percentage. This was not supposed to simply translate simply into how much money an injured person was awarded, but of course that is exactly what happened. Since pain cannot be measured it had to be left out of the calculation, so you can have terrible pain, but if you have only lost a few measurable degrees of back movement, your percentage impairment may be minimal. The system also makes no distinction between an impairment and a disability. If you are a labourer and have a lower body injury and cannot work at all or are someone who works at a desk and can maintain their previous income, the impairment is the same. I have never learned the details of the system, as I think it a bad farce, but it is used to assess impairment in Australia, makes a lot of money for the doctors who do the medicals, and saves the insurers a fortune. Of course there are few who try to fake injury, but in my experience this is fairly rare, far rarer than insurance companies would have you believe.

But making an objective assessment of what a person can and cannot do is not easy, and so one is to pity the classifiers who want a level playing field by classifying people for the Paralympic Games. Given that each country wants to pick a team of winners and they classify their own athletes, it is little wonder that in some countries ‘intellectually disabled’ are as smart as anyone else, or that you cannot even notice a limp in some of the runners.

The 4 corners of Monday 2 April looked at the whole Paralympic Classification system and produced damning figures that 10 of 12 of the gold medal winning Spanish basketball were not disabled at all, and that in some areas 69% of the winners had minimal disability.

As this sad farce continues there is a huge kerfuffle lest the tiny number of trans athletes with the genetic advantage of having had male hormones might get an advantage over females.

John Grant must be turning in his grave.

24/11/2022

iCare- a letter to the Editor of the Sydney Morning Herald

24 November 2022

Dear Editor,
iCare was set up by private insurers on their model with the NSW government keen to minimise costs, take profits and distribute them (just before the last election). So iCare delays or refuses treatments to the needy, and was very careless about what their Pre-Accident Average Weekly Earnings (PIAWE) were. Many accident victims complained that they were underpaid, and that was before their compensation was stopped or cut because they were certified partially fit to do jobs that could not be found.

The overheads of Medicare are about 5%, iCare about 38%, so it is totally inefficient as well as incompetent with bloated salaries for the top executives who think it is a financial problem rather than a medical one and hence are unable to solve it. The real solution would be to fund Medicare as the only medical system and let the insurers have widespread income-guarantee insurance.
Sincerely
Dr Chesterfield-Evans- works as a GP specialising in Workers Comp and CTP injuries.

Here is an article from today’s SMH

EXCLUSIVE
Injured workers to lose benefits
Adele Ferguson

Greg Dayman is one of almost 400 workers who will get a Christmas ‘‘present’’ they will never forget.

The Sydney construction worker was badly injured on a building site in 2013, which left him unable to work with chronic pain in his neck, the side of his head, down his arm, torso and leg.

In 2017 he was among thousands of employees whose compensation payments to cover wages were cut as part of controversial reforms to the state’s scandal-ridden icare organisation. Changes to the legislation terminated injured workers receiving weekly wage benefits after five years unless they met a whole body impairment assessment of more than 20 per cent.
However, he still received medical or health benefits. Now he has found out even these will be cut from December 25.

‘‘It’s another upper-cut,’’ he said. ‘‘And to do it on Christmas Day, that’s just cruel.’’

Dayman is one of 395 workers facing a grim future as a crisis at icare deepens, with a document prepared by the State Insurance Regulatory Authority (SIRA) revealing the workers’ compensation scheme ‘‘has deteriorated to the point the longer-term sustainability of the scheme is under threat’’.

NSW Auditor-General Margaret Crawford will hold a performance audit into icare next year that will examine how effectively key risks are managed, including the rising cost of workers’ compensation claims and its payment processes. Dayman said he lost everything after his injury.

‘‘I lost my health, my career, and financially I’m in a position that if my specs break I can’t afford to buy them. The system dehumanises you, so you give up.’’

He does now qualify for a disability pension but will have to rely on Medicare for future medical treatment. ‘‘I have been suicidal at times because of the system and the way it treats you,’’ he said. ‘‘My time is spent trying to survive.’’

In the executive summary of SIRA’s review into icare’s Nominal Insurer Improvement Plan, dated September 26, the authority said it had a ‘‘low level’’ of confidence icare’s strategy would improve return to work rates and overall performance.

In 2015-16, 93 per cent of injured workers were back at work 26 weeks after their injury, compared with 84 per cent in August 2022.
SIRA said it believed icare’s strategy ‘‘encompasses an increase in work capacity decisions to cease worker benefits instead of focusing on improving health and recovery through return to work’’.
Richard Harding, icare’s managing director and CEO, said it was the insurer’s role to implement the law, and legislation ‘‘does not give icare any discretion to act outside that’’. ‘‘Tailored and individualised support is provided to workers transitioning from the workers’ compensation scheme,’’ he said. ‘‘This may include support from NDIS, Community Support Services and Medicare in conjunction with their GP.’’

This masthead this week revealed a third underpayment scandal of injured workers and concerns raised by NSW Treasury in August that a deterioration in icare’s finances would require insurance premiums to rise 33 per cent by 2025, or $1 billion a year, to cover the shortfall.

Against this backdrop, the icare board granted pay increases to 116 of its executives, including Harding, making him one of the state’s top-paid public servants, earning more than $1 million a year.
Shadow Treasurer Daniel Mookhey said icare’s finances were in a catastrophic condition.

‘‘They’ve lost billions. They are planning massive premium hikes. And their next step is to expel even more injured workers from the system,’’ he said.

‘‘It is a ruthless tactic stemming from their financial desperation.’’
In a statement, SIRA chief executive Adam Dent said its views on the Nominal Insurer Improvement Plan in September were made with limited detail on how the plan would be executed.

‘‘Over recent weeks, SIRA has continued to engage with icare to address information gaps, including detailed briefings on managing IT and transition risks associated with the onboarding of new claims services providers.’’

But SIRA said poor return to work performance continued to be an issue of concern.

‘‘Icare’s targets for 2023 are lower than current return to work rates, and they are projecting a further decline of 2.5 per cent on 26-week return to work rates through 2023 and 2024 as the scheme transitions to new claims providers,’’ Dent said.

Icare said its focus was building injured workers’ capacity for employment using rehabilitation providers and associated vocational placement interventions. ‘‘This includes assistance with job seeking and vocational retraining. Work capacity decision-making is applied when the worker has a demonstrated capacity for work and has been provided the right support.’’
Lifeline: 13 11 14

20/05/2022

Government protects Bonuses of iCare Executives while workers are dudded.

20 May 2022

Some things make me unspeakably angry.

In the SMH online today the government giving bonuses to executives who presided over iCare cheating injured people out of their payments and treatments.

In my real job, I treat injured workers and motor vehicle accidents. Many wait more than a year for surgery- my longest was 9 years. They are subjected to Independent Medical Examinations that find any other reason than their accident for the cause of their pain. Age, previous injury and arthritis are the commonest ones. It is stated that they are fit for work, when they are obviously not, or that they can get another job when they obviously have no physical or mental capacity to do another job, let alone compete for one.

The ongoing inefficiency of the computer algorithms making decisions without even anyone being responsible was the brainchild of John Nagle, whose other bright idea was to change his KPI (Key Performance Indicator) from getting people back to work, to having them declared fit to be back to work. Nagle resigned after a bad day at a Parliamentary inquiry. All this happened while iCare was under Treasurer Dominic Perrottet.

A friend of mine injured his back lifting on a Friday. He called his GP and visited him on Saturday. He had an MRI scan on Monday which showed a bad disc injury, saw the neurosurgeon on Thursday, had a discectomy on Saturday and went home on Monday. All fixed in 8 days. That is what should happen. It never happens in the WC or CTP system.

The Workers Comp system takes 14 days to accept liability, then has to ‘decide’ if the treatment is appropriate, so weeks go by, and if they dispute it, years. People wait 3 months for the insurer’s medical examination, 6 weeks for the result of it, another couple of months for their specialist examination and a few months for the government medical to settle the dispute. And they blame the injured people for the worse results out of the system, and give bonuses to those who managed to reduce the costs. Given the huge administrative machinery, the clerk, investigators, extra medical examiners, lawyers, dispute resolvers and the rest, all the savings come from not treating people. And those responsible get bonuses, and the government, ever keen not to upset the private sector ring-ins makes sure that they are amply rewarded for this appalling situation. Perrottet, the most recent architect of iCare, had a 2^nd inquiry by McDougall to kick the can down the road, then rose to be premier before his report was out.

Here is the SMH article:

Government votes to protect bonuses for icare executives

By Lucy Cormack

May 20, 2022 — 5.00am

The Perrottet government has protected bonus payments for icare executives, rejecting a bid to ban the practice after revelations millions of dollars in bonuses were handed out while injured workers were underpaid.

The attempt to strip bonuses from executives at the state insurer was contained in Opposition amendments blocked in the lower house this week during a vote to amend the state insurance and care legislation.

Icare has been the subject of intense scrutiny since an investigation by the Herald and ABC TV’s Four Corners in 2020 revealed the underpayment of workers while senior executives claimed almost $4 million in salaries and bonuses.

The insurer, which provides workers’ compensation insurance to 3.6 million public and private sector employees in NSW, has since been forced to repay $38 million to 53,000 injured workers.

The scandal prompted the government to amend legislation governing icare, following a review by former judge Robert McDougall, QC.

More than 200 icare employees are entitled to bonuses, including chief executive officer Richard Harding, who is entitled to an incentive of $411,000.

Opposition treasury spokesman Daniel Mookhey said there was little justification for bonuses while the insurer continued to record billions of dollars in underwriting losses.

“Employers are staring down the barrel of a decade of rising premiums, yet the government is protecting bonuses for top executives at Australia’s most disaster-prone insurer,” Mookhey said.

“We intend to stand up for employers and injured workers. We will fight against lavish bonuses for icare’s top executives in the Legislative Council next week.”

During debate on Wednesday, Minister for the State Insurance Regulatory Authority Victor Dominello said the McDougall Review had not found executive bonuses at icare were excessive.

He said McDougall noted the benefit of allowing icare to set competitive salaries to “attract appropriate talent”

The Herald last year revealed icare hired 18 new executives with potential annual bonuses collectively worth more than $1.2 million, while employee operating costs have increased from $162 million to more than $200 million since 2020.

However, an icare spokesman previously told the Herald no executive bonuses have been paid in the past two years.

Unions NSW boss Mark Morey wrote to NSW MPs last week calling for reforms to address “repeated governance, financial and operational crises”, including ending executive bonuses.

Other proposed reforms included enforcing the same procurement laws that govern the NSW public sector, from which icare is exempt, and appointing an injured worker to the board.

Morey on Thursday said the government had missed an opportunity to “clean up” the state insurer.

“How can the premier justify continued bonuses for highly paid executives when sick and injured workers have been dudded and small businesses are paying increased premiums?” he said.

Other changes sought by the government included additional powers for the State Insurance Regulatory Authority and expanded access to commutation, which allows injured workers to negotiate lump sum payments and exit the system, rather than remain on weekly payments.

However, the government agreed to withdraw its proposal to allow changes to commutations via regulation and reconsider them in future legislation.

Opposition spokeswoman for industrial relations, work, health and safety Sophie Cotsis said she was pleased the government had agreed to consult further on lump sum payments, arguing that regulation should not be used to expand the system.

The State Insurance and Care Legislation Amendment Bill 2022 will now move to the upper house, where the opposition will make another attempt to ban bonuses.

08/04/2022

Bullshit Jobs

8 April 2022

The idea of bullshit jobs is not new. It comes from a book in 2018.

However, with employment supposedly doing well, largely because we have excluded guest workers due to Covid, it is worth looking at how many jobs are actually needed.

Everyone needs something to do and a reasonable income to live on. The status of having a job relates generally to its perceived income, though there is some ‘doing good’ status associated with jobs like nursing despite their being chronically underpaid.

But technology replacing people has not brought the expected benefits because there seems no plan to spread the benefits evenly, or look at whether what is being done has any social utility. Many jobs that need doing are not done. Many people who want to work cannot, yet much energy and money is spent doing useless things.

I waste about 80% of my time as I treat Workers Comp and CTP injuries. About 20% of my time is deciding what treatment is needed, and about 80% filling in paperwork or writing reports to try to get the treatments paid for. On the other side there are a phalanx of clerks trying not to pay and to transfer the costs elsewhere. (i.e. to Private Health Insurance, Medicare or the patient themselves). Many doctors and lawyers also strive mightily in this unproductive area. The bottom line is that while the overheads of Medicare are about 4.5%, the overheads of CTP are close to 50%,; i.e half the money goes in processing or disputing claims or in profits for the companies indulging in this nonsense. And since many patients often cannot get the treatment or suffer long delays because of their efforts, it is a really bad use of human energy.

Someone needs to look hard at what we do and where the benefits go. Assuming that ‘the market’ will fix it is about as sensible as saying that ‘God’ will fix it, and is usually espoused with the same uncritical zeal.

Here is Wikipedia summary of the book:

In Bullshit Jobs, American anthropologist David Graeber posits that the productivity benefits of automation have not led to a 15-hour workweek, as predicted by economist John Maynard Keynes in 1930, but instead to “bullshit jobs”: “a form of paid employment that is so completely pointless, unnecessary, or pernicious that even the employee cannot justify its existence even though, as part of the conditions of employment, the employee feels obliged to pretend that this is not the case.”[1] While these jobs can offer good compensation and ample free time, Graeber holds that the pointlessness of the work grates at their humanity and creates a “profound psychological violence”.[1]

The author contends that more than half of societal work is pointless, both large parts of some jobs and, as he describes, five types of entirely pointless jobs:

flunkies, who serve to make their superiors feel important, e.g., receptionists, administrative assistants, door attendants, store greeters, makers of websites whose sites neglect ease of use and speed for looks;
goons, who act to harm or deceive others on behalf of their employer, e.g., lobbyists, corporate lawyers, telemarketers, public relations specialists, community managers;
duct tapers, who temporarily fix problems that could be fixed permanently, e.g., programmers repairing bloated code, airline desk staff who calm passengers whose bags do not arrive;
box tickers, who create the appearance that something useful is being done when it is not, e.g., survey administrators, in-house magazine journalists, corporate compliance officers, quality service managers;
taskmasters, who create extra work for those who do not need it, e.g., middle management, leadership professionals.[2][1]

Graeber argues that these jobs are largely in the private sector despite the idea that market competition would root out such inefficiencies. In companies, he concludes that the rise of service sector jobs owes less to economic need than to “managerial feudalism”, in which employers need underlings in order to feel important and maintain competitive status and power.[1][2] In society, he credits the Puritan-capitalist work ethic for making the labor of capitalism into religious duty: that workers did not reap advances in productivity as a reduced workday because, as a societal norm, they believe that work determines their self-worth, even as they find that work pointless. Graeber describes this cycle as “profound psychological violence”[2] and “a scar across our collective soul”.[3] Graeber suggests that one of the challenges to confronting our feelings about bullshit jobs is a lack of a behavioral script in much the same way that people are unsure of how to feel if they are the object of unrequited love. In turn, rather than correcting this system, Graeber writes, individuals attack those whose jobs are innately fulfilling.[3]

Graeber holds that work as a source of virtue is a recent idea, that work was disdained by the aristocracy in classical times, but inverted as virtuous through then-radical philosophers like John Locke. The Puritan idea of virtue through suffering justified the toil of the working classes as noble.[2] And so, Graeber continues, bullshit jobs justify contemporary patterns of living: that the pains of dull work are suitable justification for the ability to fulfill consumer desires, and that fulfilling those desires is indeed the reward for suffering through pointless work. Accordingly, over time, the prosperity extracted from technological advances has been reinvested into industry and consumer growth for its own sake rather than the purchase of additional leisure time from work.[1] Bullshit jobs also serve political ends, in which political parties are more concerned about having jobs than whether the jobs are fulfilling. In addition, he contends, populations occupied with busy work have less time to revolt.[3]

As a potential solution, Graeber suggests universal basic income, a livable benefit paid to all, without qualification, which would let people work at their leisure.[2] The author credits a natural human work cycle of cramming and slacking as the most productive way to work, as farmers, fishers, warriors, and novelists vary in the rigor of work based on the need for productivity, not the standard working hours, which can appear arbitrary when compared to cycles of productivity. Graeber contends that time not spent pursuing pointless work could instead be spent pursuing creative activities.[1]

24/02/2022

Loneliness and its solutions

25 February 2022

I sometimes watch Foreign Correspondent on ABC TV and by chance on 15/2/21 I came across this excellent programme on loneliness in Japan.

The ABC correspondent there looks at loneliness in the Japanese population from older folk dying alone, to younger people simply withdrawing from society.

Some of the older ones had no family or jobs. Some of the younger ones were so pressured to succeed and felt that they had failed, so simply withdrew from society. It seems that the pressure on kids all to be CEOs is an absurd and unachievable objective.

I am not sure that the situation in Australia is as bad, but I thought about some of my patients and could think of half a dozen immediately. With some of them , I am one of the only two or three people in the world they have any contact with, their relationships are tenuous.

None of them started with mental health problems. Here are some examples:

A 60 year old man worked for a security company looking after an insurance company. He was doing surveillance for them, but it took over his life as he was contacted 24 hours a day for various crises. Case management employees having conscience over what they were doing had to be rescued from self-harm in the toilets. Enraged claimants with refused claims threatened to blow up the company offices with cans of petrol. He saw staff high-fiveing as some claimant got a derisory settlement when they deserved and needed a lot more. It went on like this for years. When he said that he could not do this anymore he was treated as badly as any of the people he had dealt with. He told me this story, and I had hoped that with his considerable management skills and experience, he could be put into a less stressful position. But he deteriorated. Everything reminds him of the corruption of the world. He is estranged from his wife and they communicate with post-it notes on the frig. He goes for a walk at 11 at night so he will not have to speak to people in the street. One son has stuck by him and visits daily, and will build him a self-contained unit in his new home.

Another patient is a 62 year old ethnic taxi driver who was so badly bashed 11 years ago by a gang stealing his takings that he lost an eye, has never worked again and never recovered mentally or physically. He was divorced; lives alone and sometimes will not even answer the phone.

One is a 42 year old foreign student who came to study theology, wanting to become a pastor. Her English is not great. She is a trifle unworldly, and thought that the world is basically kind and people look after each other. She had a casual job in a motel and her boss asked her to move a bed down the stairs between floors. She said it was too heavy and she could not, but he threatened to sack her. She did it and got an injury to two discs in her back. She was frightened to have surgery, so was in agony for a couple of years and eventually agreed. She had minimal surgery, which was not successful. The insurer decided that she was not complying with what they wanted so refused to pay her. She was effectively broke and homeless, so an old lady from her church offered her a bed and food. But she lives a long way away and up a drive that is hard for my patient to walk up. She was effectively trapped. As a foreign person she did not even have Medicare for the minimal psychological help it offers (6 visits a year). Her mental health deteriorated and she shunned all outside contact, and would not even answer the phone. She has gone home to her family- I can only hope she improves there.

One is a 39 year old from a religious and teetotal family with a high sense of ethics. He was a top salesman of a computer company and became aware that they were ripping off some customers. He drew this to management’s attention, but they declined to do anything and he was labelled a whistleblower. Management supported him by putting out an email asking that he be supported for his mental health issues. He felt that this ostracisation was the end of his career, because he had asked them to behave ethically. He was certain that no one in his tight top group will now employ him, so he withdrew and started to drink to lessen the pain. His family then rejected him because of the drinking and his sales friends are estranged also. The psychologist gives him Cognitive Behavioural Therapy exercises and I try to get him to drink less and somewhat ironically counsel him that you cannot withdraw from the world merely because the baddies generally win. He lives alone, answers the phone and is just able to do his own shopping, but is not improving much.

These are just some examples that I know. Coasting home as GP at least keeps you in contact with life. The point is that many people have broken lives, but just keep living. None of these examples have done anything wrong themselves. Is a sense of ethics a mental illness?

As everyone has to ‘look after themselves’ in a consumer-oriented society, more people will fall through the cracks, especially as the gap between rich and poor is enlarged by pork barrelling which puts resources into areas that need them less, tax breaks for the rich, subsidies for private schools and private health insurance, derisory welfare payments, and insurers allowed simply to refuse to pay without penalty.

People need basic support with universal housing and universal health case. They need jobs or at least occupations and an adequate income to survive. And we need outreach and support services that can be called upon.
When people say, ‘There are not enough jobs’, they are taking nonsense. Anyone can think of many worthwhile things that need doing. And there are plenty of people who would be happy to do them. The problem is that in a world where nothing can be done that does not make a profit, a lot of things that need doing are not done. That is where the policy change are needed. We cannot simply look at the money and see to what level existing activities can be maintained. We need to look at what needs to be done, and then work out how to achieve it. We need to decide that everyone has a right to live and those who have a good life will live in a better society if everyone can share at least a basic quality of life. There has to be recognition that the ability to be profitable need not be the overwhelming criterion for what is done. Tax may go up, but if there is real re-think of priorities, it is not likely to be all that much.

The link to the ABC program that initiated this tirade is below.
https://iview.abc.net.au/show/foreign-correspondent/series/2022/video/NC2210H002S00

11/11/2021

iCare will repay 53,000 underpaid injured workers

11 November 2021

iCare, the State workers’ compensation insurer has admitted that it has underpaid thousands of workers and will now repay them, according to an article in today’s SMH.

This story has been leaking out in the media for ages. At a day to day level, my patients have always complained that they get a lot less in compo than they got before their injury. This has been even for workers on regular salaries. Those on casual work were in a worse situation as there was some argument about what their PIAWE (Pre-Injury Average Weekly Earnings) were, especially if they got variable hours from a labour-hire company.

When this scandal first broke, I tried to tell my patients to ask iCare if they had been underpaid and some did. It seemed that iCare could not work out what their PIAWEs were. It did not have the data. In that employers’ future premiums related to how much was paid out in claims, it suited both the employers and the insurers to minimise their PIAWE, so if a low amount was put in, there was little incentive to check it up. Now, a few years later, iCare would need a forensic accountant going through the employer’s books to get to the correct amount. This is unlikely to happen.

So while this promise is a start, it is hard to believe that it will be enough to see justice done.

Workers’ Compensation has always been seen as a cost for business rather than a moral obligation to pay for people injured at work. Generally it is about minimising the cost of the payout, rather than having an energetic injury prevention programme.

The Minister in charge is the Treasurer, so all of this happened on Dominic Perrottet’s watch. Matt Kean, the new Treasurer may be more sympathetic, and this will help, but we still need a lot better enforcement of safety to prevent accidents, and much more power to injured people to ensure that they are correctly paid.

It illustrates that active Unions are necessary to redress the power imbalances in the the system. Legislation without enforcement is just words on a page, just as apologies from banks and insurance companies for rip-offs are just sound vibrations in the air.

Here is the article:

‘My sincere apology’: iCare will pay back $38 million to 53,000 injured workers

Lucy Cormack SMH November 11, 2021

State insurer iCare will pay $38 million to 53,000 largely underpaid injured workers affected by historic miscalculation errors between 2012 and 2019.

An iCare review of 16,000 injured worker case files has revealed an average error rate of 3.5 per cent or an underpayment of $26 a week due to miscalculated pre-injury average weekly earnings.

“I would like to offer my sincere apology to any injured worker who has been affected by this calculation error,” said ICare chief executive Richard Harding.

Among the most seriously injured and affected are 523 workers underpaid a total of more than $3.9 million, or around $7500 each.

The mass pay-out follows a joint investigation by The Sydney Morning Herald, The Age and ABC’s Four Corners which last year revealed iCare had underpaid as many as 52,000 injured workers by up to $80 million in compensation.

ICare then disputed the underpayment figures, saying it believed only 5000 to 10,000 workers had been underpaid up to $10 million in total.

Chief executive officer Richard Harding on Thursday said affected employers and employees had been unable to provide the data to accurately assess underpayments. As a result, iCare conducted a “file by file review” of 16,000 cases as a sample to assess the scale of the errors.

“We’ve been advised there is a risk of overcompensation in this approach, but the desire is to get money back as quickly as possible,” Mr Harding said.

“I would like to offer my sincere apology to any injured worker who has been affected by this calculation error.”

The underpayments were caused by errors in the calculation of pre-injury average weekly earnings for injured workers dating back to 2012, when the insurance scheme was run by WorkCover.

Mr Harding said the average lump sum to be paid to the 53,000 workers will be around $700. However, some will receive thousands.

Affected workers will receive any money owed through an adjustment of their weekly benefits for the weeks already paid. Any historical overpayments caused by the same miscalculation error will not be recouped by iCare.

Revelations of financial mismanagement and widespread underpayment across the iCare stable first emerged last year, before a subsequent review into its culture and governance revealed systemic weaknesses and a failure to hold management to account.

Labor treasury spokesman Daniel Mooched said the announcement repudiated earlier claims that only a small number of people were affected.

“As always with iCare, the devil is in the detail. But today’s announcement is meaningful for the tens of thousands of people iCare underpaid”.

Mr Mookhey said the insurer must guarantee that it will not seek to recover the money from sick and injured workers through benefit cuts or employers through higher premiums.

Upper house Greens MP David Shoebridge said the pay-out to workers followed years of chasing by unions, injured workers and non-government MPs.

While he welcomed the payments, he said there was “no evidence from iCare that this payment goes anywhere near meeting their full obligation to injured workers”.

“We will continue to press iCare for a full accounting so that no injured worker is left short-changed,” he said.

Unions have described the decision to reimburse workers as a significant step but called for greater transparency about the process.

“This is hardly an organisation that can be taken at its word. iCare executives, who are better known for receiving fat bonuses, must detail their methodology,” said Mark Morey, Secretary of Unions NSW.

Last week, a budget estimates hearing heard iCare had reported a $1.4 billion underwriting loss in the past year, with the total accumulated loss of the past three years now exceeding $6 billion.

Treasurer Matt Kean, who is responsible for iCare, told the hearing new legislation following recommendations from another review prompted by the scandal would not be introduced until 2022.

22/09/2021

Victorian Government Bites the Bullet and Mandates Vaccination

22 September 2021

At last! A government that does the sensible thing. The Victorian government will only open up if people are vaccinated. Thanks to NSW the Delta variant genie is out of the bottle and spreading nationwide. Business wants to unlock, some with no care for anyone but themselves.

Victoria wants to unlock but minimise spread among those now having more interpersonal contacts. The R (Reproduction) number is the number of cases each case infects. If everyone is vaccinated, less people will get it and those who have it will get it to less people.

Reasonable medical opinion is that the risks of vaccine are massively less than the risks of getting COVID, so the case against vaccination is incredibly weak on medical grounds. The ‘right not to have your body violated’ etc sounds very dramatic, and makes vaccination equivalent to rape in a semantic sense. But in a practical sense the two concepts are as far apart as could be. One is sensible medicine and the other is a crime.

Anyone who thinks that this does not matter should look at the graph of NSW cases that has peaked and is just starting to fall. Anything that can flatten the curve or make it fall is good. Anything that makes it rise is creating deaths and misery.

I am a member of the Council for Civil Liberties and have spent years working against excess government power. But sometimes it is necessary to act for the common good. I have no time for smokers’ rights or the right to spread disease. The Morrison government is as usual missing in action when real leadership is needed. ‘Let every workplace decide’, is a nightmare for retail business owners, offices and just about every other employer. Gladys is similarly missing. Dan Andrews has stepped up, despite a motley crew in the streets spreading disease and demanding the right to continue to do so.

What of the Health System? We are going the way of the Americans by stealth, and the fact that the public system is what has helped us survive is being glossed over, hidden by subsidies to private hospitals. The Federal government has been quietly trying to kill public medicine for years. The Medicare rebate has fallen from 85% of the AMA rate to 45%, so for the same bulk-billing work doctors incomes have almost halved over 35 years, while subsidies to the inefficient Private Health Insurers continue. Being a GP is now a little-sought speciality. (I have a FB page- Fix Medicare that I spend too little time on).

The States have maintained the public hospitals at a minimal level, as all the lucrative work has been siphoned off by the private system basically doing the easy stuff. There is No slack in the system, not that counting the number of ICU beds should factor. All our efforts should be to keep people out of Hospital and ICU by prevention of infection.

Have a look at this article on the anti-discrimination aspects of mandatory vaccination, and also look at the NSW cases, just turning down, but likely to rise if anything, like opening up from lockdown, tips the balance.

www.smh.com.au/national/victoria/here-s-why-no-jab-no-entry-is-not-discrimination-20210920-p58t2v.html?fbclid=IwAR2jrbfGJsq6fD-J-unnAn12j9UyWvdk-do5BpE23bI0z0gQ8kknq5nc39c