Misleadership The Liberal Party of Australia hates Medicare. They hate it purely on the basis that it was introduced by the Australian Labor Party and has been a great, transformative success; and that it is a benefit to the poor. Opposition to Labor is ingrained in this mob. They preference the big end of town on the basis that it from this source that they derive their legitimacy. Therefore any success by Labor must be rolled back. That Medicare has been so successful and so popular presents a challenge to them, however, so they must be duplicitous in how they reverse the program. Deep-seated resentment of the poor in a philosophical matter: like puritanical conservatives of the American Republican party, they believe the poor deserve their condition, that it is a moral failing. This extends to the elderly and sick. Wealth and good health are the rewards of providence for virtue and the evidence of it. So when the current Minister for Health, Sussan Ley, announces a review of Medicare, this would be a welcome development, from any other set of politicians. The review will include all procedures, tests and treatments, on the basis that there is a need to reduce “inappropriate tests and procedures”, because, primarily, many are no longer used. Of course, a test, treatment, or procedure that is no longer used isn’t costing anything, but that’s not the point. The point is to simply to stop spending money on health care. The review will also examine new ways of paying GPs, which is fine, potentially working towards a better system of managed care, to reduce the need for more complex procedures and interventions such as now inevitably arise from the lack of management of conditions such as obesity, diabetes, heart disease, etc. Early intervention and management over the longer term means fewer people needing emergency and more costly interventions later. This, of course, costs money now, but reduces spending overall. Don’t expect this to be an outcome of the review. Instead, expect GP care to become part of private medical insurance coverage, shifting the cost from Medicare to the consumer and killing off bulk-billing as effectively as the previously mooted co-pay and rebate reductions. New rules are expected to be implemented to address the issue of Medicare cheats. But it’s actually doctors rorting the system more so than it is patients, and you would be foolish to believe that’s going to be the focus of the review. Instead, the “Medicare cheating” to be addressed will be rules to make it more difficult for the poor and middle class to access Medicare on the basis they are accustomed to, requiring more out-of-pocket expenditures and a reduction in services. The Australian Medical Association and Consumers Health Forum may welcome the review, but they should be cautious in their embrace of it, like the farmer and the viper. We know who these Liberals are, and their nature.

The System Reading the latest New Yorker (the latest I’ve received to date, delivery being somewhat more delayed than it would be if I were still a local), I encountered an article by Adam Kirsch, ”The System”, reviewing two new books on the Nazi concentration camps, both of which sounding quite excellent and quite terrifying. I was struck by the final paragraph, in a more contemporary context: Australia’s treatment of asylum seekers. ”The impulse to separate some groups of people from the category of the human is, however, a universal one. The enemies we kill in war, the convicted prisoners we lock up for life, even the distant workers who manufacture our clothes and toys – how could any society function if the full humanity of all these were taken into account? In a decent society, there are laws to resist such dehumanisation , and institutional and moral forces to protest it. When guards at Rikers Isalnd beat a prisoner to death, or when workers in China making iPhones begin to commit suicide out of despair, we regard these as intolerable evils that must be cured. It is when a society decides that some people deserve to be treated this way – that it is not just inevitable but right to deprive whole categories of people of their humanity that a crime on the scale of the [concentration camp] ecomes a possibility. It is a crime that has been repeated too many times, in too many places, for us to dismiss it with the simple promise of never again. Australia, it seems, has decided, and we deserve every condemnation for it.

Health Care & Aged Care Our illustrious Treasurer, Joe Hockey, is trying to sell the nation on the idea that we have to have a co-pay for visiting a doctor, or that the payments to doctors for short appointments needs to be reduced, because somewhere in the world today a child may be born who will live to 150 years of age. Of course, if he can't afford health care because, after he's paid his Medicare levy etc. he can't afford the co-pay, or doctors no longer bulk-bill so they can make up the shortfall imposed by government, he won't live so long and certainly not well. Hockey also relates the story of only having to pay $40 for the treatment of his son's broken foot. He says that was "inherently wrong", because he could afford to have paid more. No, Joe, that doesn't make it wrong. You - and the rest of us - pay the Medicare levy so that we can access health care. That's what it's for. We may need to raise the levy. The levy may only be raising half the annual cost. But there are other initiatives that can be taken and that would make sense to improve health care delivery and maintain access for everyone. You only need to read a newspaper to find out about them, or talk to actual health care professionals. It might mean more money spent now and less - significantly less - later, but it puts the program on a progressive track, taking advantage of new technologies, new techniques, new and better practices. But that's not what this government wants to do. At best their ideological commitment to "small government", something they never fail to fail to achieve, demonstrates a complete misapprehension that government is the one organisation that can apply the leverage needed to make things better. At worst it's simply that they hate Medicare. They hate the very idea of someone else getting something they think they're not getting - even when they are. Good Catholic boys who heard "the poor you will have with you always" and learned the wrong lesson from the story, they've somehow adopted the mindset that being poor or ill is a moral failing. Joe Hockey, Tony Abbott, our current and former health ministers, they are lying. Medicare is not "unsustainable", and we do not need to inflict "price signals" on health care.

Paying for It The Liberals are abandoning their proposed $7 co-pay for doctor visits: good. It was a bad policy. The policy proposed adding this out-of-pocket tax to pay for a so-called “medical research future fund”, but the purpose was quite simply to drive people away from doctors, based on the claim that too many were going too often for too little. Are there people turning up at their bulk-billing physician’s office or clinic at the least sign of a sniffle or just because they’re lonely? Probably, but that doesn’t make Medicare “unsustainable”, as is so often claimed to be its status. In fact, Medicare is eminently sustainable, but health care itself does need work. I read a lot about various efforts being undertaken to improve health care delivery in the US and elsewhere. These may involve larger initial outlays, but the outcomes produced provide significant reductions in long-term costs well-beyond what’s spent at the beginning, and overall patient health is similarly improved. That’s big, as big, in its way, as antibiotics. It’s also smart, much smarter than driving people away from doctors or increasing the tax used to pay for health care. The supporters of the tax call it “structural reform”, but it isn’t a reform, unless you think abandoning universal health care is a reform, and it isn’t structural, as it doesn’t address health care itself. Pushing people away from health care is only going to make it more expensive as more people end up with worse health an earlier intervention could have prevented. Pushing health care into the private sector will not only increase costs, it will make it unavailable to the poor and burden the middle class, but that’s the idea, really. Liberals hate the poor. They regard poverty and illness as moral failings that should be punished. They despise the middle class for being aspirational and sucking up money that belongs to the wealthy. This is an ideological driver for the party and for the policies they seek to enact. That and the fact that Medicare was a successful Labor Party initiative for the last forty years, and nothing Labor has ever done can be tolerated. The Liberals have decided on a practice of extreme opposition, even in government, and this is one of the worst actions they’ve yet undertaken. Don’t count on the “co-pay” tax being gone forever. The Liberals are nothing if not persistent. Update: Absent the ability to put through their tax, the Liberals now propose to effectively stop paying doctors what they're owed for providing health care under Medicare. This is a despicable abrogation of their responsibility to the public and a slap in the face to doctors.

Dear Tony Do you have any of those fridge magnets left that prevent terrorism? I lost mine and now there's women in burqas everywhere!

The Nanny State Becomes the Police State When the USA Patriot Act went up, we knew it was a bad job. Sure, mostly because John Ashcroft was part of it . . . o.k., not mostly, but don’t discount the influence of evil. But bad. The whole NSA scandal came straight out of the this act, among other things. And now Australia, the ten-years-later me-too nation, is headed into the same error. Laws passed today, without significant dissent, will allow the Federal Attorney General to issue warrants for Australian police and spy agencies to tap phones, internet usage, and conduct searches, without judicial oversight or even, effectively probably cause. These police will be exempt from prosecution for any misdeeds – except, incredibly, torture, by the specific concern on one Liberal Party member at the concession of the AG, as if the rest of what abuses may occur are irrelevant. Why? Because some Syrian blowhard recommended killing, among others, Australians, on behalf of the so-called Islamic State. Naturally, some weak-minded moron proceeded to attempt exactly that, was shot and killed for his efforts, and the whole nation is in an uproar of fear and loathing. It’s gone so far that there are police with assault rifles patrolling the halls of Parliament House and more weak-minded morons saying Ban the Burqa (as if wearing a veil was a common tool of suicide bombers even in those countries where it’s commonly worn, among which Australia is not). “Less freedom for some for the protection of the rest” is the mantra we’re being conned with. More freedom reduces risk, especially if it can be grown in those countries where freedom is severely restricted , but it isn’t really about suicide bombers, beheadings, or what threat IS actually poses here or abroad to anyone, let alone Australians. It’s about power. And as we saw in the States, once power is gained it is not easily relinquished, even by those professing more high-minded ideals. Obama has not closed Guantanamo. He has not curtailed warrantless wiretapping. He has stepped up the use of assassination-by-drone, including against US citizens. The powers Bush established for himself and his administration have not been ceded by Obama, and any expectation that he would do so was always delusional. Why should he? Especially if, in doing so, he armed his opposition with tools to use against him? The same is true here. Howard instituted laws following the 2002 Bali bombings that were a USA Patriot Act lite. Rudd and Gillard, achieving government in 2007 did nothing to dismantle them, and while the spying on Indonesia is likely to have commenced under Howard, it was certainly escalated under Rudd/Gillard, to the point of tapping the Indonesian president’s wife’s phone. Abbott caught the flak on that one, but he didn’t back off it. And now we have more laws, more extensive spying, domestic and international, with plenty of exemptions to keep the spies from answering to any abuses they inflict, either procedural or physical. They may stop short of torture, but we know from the Bush Justice Department how easy it is to redefine torture. These laws are wrong, but they’re never going away. What a mess.

Medical Care, If You Can Pay for It In case you weren't listening in the lead-up to last year's September election, Tony Abbott promised no fundamental changes to, among other things, Medicare. In case you were dropped on your head as a child, Tony Abbott was lying. Today we have proof. Health Minister Peter Dutton, one of John Howard's henchmen prior to the 2007 election that saw the exit of the Liberals from government, has announced: "one important job of the Abbott Government is to grow the opportunity for those Australians who can afford to do so to contribute to their own healthcare costs." No, really, he said "grow the opportunity." What he means, of course, is that Medicare is not going to be universal health care in Australia anymore. It will be user-pays. Now, keep in mind that we already all pay a tax levy to fund Medicare, and that this levy, in the last, Labor, goverment, became means-tested (so that those "who can afford to do so" are already paying more to fund heathcare costs - not just for themselves, but for the whole country; and that, under Howard, it became compulsory to hold private health care insurance, the premiums for which are regularly approved for substantial increases. But we're going to "grow the opportunity" to pay more - not for the country overall, but for our "own healthcare costs." I do not object to paying taxes. Taxes are a public good and the price of living in a society. The society I joined has an admirable universal healthcare provision and a healthcare system that is second to none. But user-pays is the US model, pre-Obamacare (and post, pending refinements I'm sure a vast number of Americans are looking forward to under next-President Clinton), and it is the very model of unsustainable. If healthcare costs are indeed rising at unsustainable rates for Medicare, it's not Medicare that's the problem: it's the healthcare system. We need better, smarter care, not just more and paying more for it. In this latest example, Abbott and his ministers yet again prove they have no idea of the role of government, no vision, and nothing but their own pre-formed opinions on which to develop policy. We have a great opportunity to model significant advances in healthcare, but all they can think to do is to gut the system. Howard wanted an end to Medicare as much as he wanted an end of labor unions. He couldn't get it done. Abbott is well on his way to reducing the power of workers in favour of employers, and now he's proposed to complete the job of eliminating Medicare. Australia will never be the same if we let this happen.