David Leyonhjelm’s guest post “An UnhealthyApproach to Health”

Published as an op ed in The Fin Review.

Popular thinking about the role of government is all over the place. Nothing exemplifies the muddle more than the widespread support for massively increased government spending on medical research, and the noisy opposition to the proposed reduction in Medicare rebates to doctors.

Everyone supports medical research. What’s not to love? But that fact is the very reason governments shouldn’t fund it. People give freely and generously to medical research charities every day. They direct their money to the fields of research they care most about. They give when they know where the money is going. And they give to organisations that they trust.

According to research by the National Australia Bank, nearly a third of Australian tax-deductible donations last year went to cancer charities (like the National Breast Cancer Foundation), health and disability charities (like Diabetes Australia) and medical research charities (like the Heart Research Institute). This suggests that Australians freely donate more than $700 million dollars to these organisations every year.

The proposed Medical Research Future Fund aims to add a billion dollars to annual government funding of medical research in a decade’s time. But as government funding for good causes goes up, private donations go down. One study estimates that for every $100 of government funding, private donations fall by $73.

We should not ask the government to do what we can do ourselves. It robs us of our direct connection with those we want to help and makes politicians believe they are angels when being generous with other people’s money. It also generates public sector jobs in which bureaucrats serve as unnecessary middlemen rather than working in the private or not-for-profit sectors where they could add real value to people’s lives.

It is no secret that the Government’s Medical Research Future Fund was supposed to be a Trojan horse that would allow the Government to sneak in a reduction in Medicare rebates. But a reduction in Medicare rebates is not something the Government should be ashamed of, or something that could be snuck in anyway.

A reduction in Medicare rebates, and the associated increase in the prices doctors will charge patients, is good policy. The Government should be proud of it and ought to directly argue in support.

We pay mechanics to service and fix our cars, and we pay tradespeople to maintain and repair our homes. This arrangement works. Many mechanics and tradespeople compete for our custom by developing a reputation for good work, honesty, and good value. Those that don’t, risk going out of business.

Our bodies are more valuable than our cars and homes, and the services provided by doctors, based on at least a decade of training, are more valuable than the services of mechanics and tradespeople. As such, there is no more important place to encourage good work, honesty and good value than the doctor’s surgery.

Various arguments are made to oppose the introduction of charges for a visit to the doctor. Rather than hide behind the Medical Research Future Fund, the Government should rebut each of them.

It is said the introduction of charges will hurt the poor and chronically ill. But there is a generous cap; concessional patients and children under 16 years will only have to pay $7 for the first 10 services each calendar year, a total of $70. Opposing the Government’s proposal in its entirety will only maintain a situation where the well-off and healthy receive the same level of medical support as the poor and chronically ill, a level that is inadequate for those most in need.

It is said the introduction of charges will discourage people from visiting the doctor. But some visits to the doctor should be discouraged. We cannot afford to waste the limited and valuable services of our doctors on consultations that are more social than medical. Over-servicing can worsen health outcomes.

And the mindset that good health hinges on the services of doctors rather than exercise, nutrition, sleep, social networks and low stress is a harmful mindset of dependency that free consultations only serve to reinforce.

In an ideal world we would shop for health services based on quality and price, protected from unaffordable costs by insurance. The government’s role would be limited to ensuring that the poor and chronically ill are insured, and collecting and publishing information about the providers to help us make better choices.

In that world the most needy would receive all the support they required, and private support for medical research would not be discouraged.

David Leyonhjelm is the Liberal Democrats’ Senator for NSW.

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83 Responses to David Leyonhjelm’s guest post “An UnhealthyApproach to Health”

  1. Rafe

    One study estimates that for every $100 of government funding, private donations fall by $73.

    It is probably worse than that. Terrence Kealey found three laws of funding of science. See Chapter 10 of his book “The Economic Laws of Scientific Research” Chapter 10., summarized in this e book.

    First Law. The % of national GDP spent increases with national DGP per capita.
    Second Law. Public and private funding displace each other (compete). So public funds tend to displace private funds.
    Third Law. The public/private displacement is not equal. Public funds displace a larger volume of private funds than the public input. (net loss)

  2. Percy

    Third Law. The public/private displacement is not equal. Public funds displace a larger volume of private funds than the public input

    I tend to belive this is true, however if this

    for every $100 of government funding, private donations fall by $73.

    is the case, it still means government is taking from the citizenry an amount the people feel they cannot afford to give. The end, apparently, justifies the means

  3. 2dogs

    There is a lot of middle class welfare here. Why don’t we require the privately insured to use their insurance?

    I have private insurance but paid nothing on my last trip to the doctor.

  4. Bob

    Give the research fund a few years and it will make the Australia Council look like beginners in the art of squandering money.

  5. Diogenes

    There is a lot of middle class welfare here. Why don’t we require the privately insured to use their insurance?

    For the very simple reason is that they are paying thrice for the same service,a nd if they can get it for free why not? Thrice
    1. through the compulsory medicare levy
    2. for the private health insurance premium
    3. for the “excess” on the gap between what the health fund pays out and what the doctor actully charges

    eg stepdad(80) just had his prostrate whipped out privately – he was still 5k out of pocket despite, having paid into PHI for at least 30 years, and as a SFR he pays the medicare levy.

  6. The case I see for public funding of medical research is filling the gaps that private industry can’t (or rather, have no interest in) fill. The medical effects of compounds in production for other purposes (industrial etc) is one example, but there may well be others.

    Just happens that sometimes (not necessarily often) there is a substantial public benefit, and little or no commercial benefit to be derived.

  7. Tapdog

    Why don’t we require the privately insured to use their insurance?

    It would likely increase the rate of dropout from PHI and enforcing compliance would be a prick of a job.

  8. One study estimates that for every $100 of government funding, private donations fall by $73.

    Reference that study.
    Here is a study that contradicts that.

    But some visits to the doctor should be discouraged.

    Which visits? Specify please.

    In an ideal world we would shop for health services based on quality and price, protected from unaffordable costs by insurance. The government’s role would be limited to ensuring that the poor and chronically ill are insured, and collecting and publishing information about the providers to help us make better choices.

    So health, according to your glib ideology, is a market?
    Tell me how that works for one of my clients – a seventeen year-old Aboriginal girl with severe and multiple impairments living in a remote town in South-Western Queensland.

    David, your ideology is running away with your grasp of reality.

  9. Tel

    One study estimates that for every $100 of government funding, private donations fall by $73.

    If the fuel tax is anything to go by, only about $50 out of that government $100 ends up going to the intended task.

  10. Token

    It is said the introduction of charges will hurt the poor and chronically ill. But there is a generous cap; concessional patients and children under 16 years will only have to pay $7 for the first 10 services each calendar year, a total of $70.

    What is fascinating is how the furor of the populists are drowning out the fact that this refinement of the policy is a step toward making the health system more efficient and more equitable.

    Why do people who pretend to be champions of the poor stand in the way of a policy which would see public resources re-routed from people on good incomes to programs in need?

    We were told for years that the people on the left made decisions guided by their heart over their head, yet it becomes clearer by the day they ignore their heart as well.

  11. Token

    If the fuel tax is anything to go by, only about $50 out of that government $100 ends up going to the intended task.

    We all know that this government will try to follow the letter of the law, but the next will not and move the funds into consolidated revenue while demanding higher taxes for “critical” programs.

  12. JohnA

    In an ideal world we would shop for health services based on quality and price, protected from unaffordable costs by insurance.

    Yes, I used to enjoy that – it was called “Casualty Insurance”, and before the 1986 changes to Medibank/Medicare, I was encouraged to avoid frivolous trips to the doctor because the first $500 and the first ten trips were on me.

    But the insurers were not “health insurers” these policies were general insurance to cover the risk of a financial burden beyond my ability to pay. So in 1986, the big health funds lobbied the government to nobble such general insurers. My premiums went up and then suddenly the big health funds had similar policy options – wonder of wonders!

  13. Anthony S Adams

    We all know that Joe Hockey only developed the idea of funding a research program from the copay as a way of compromising Labor. If something is worth funding we do it directly without the need for subterfuge.

  14. ar

    But there is a generous cap; concessional patients and children under 16 years will only have to pay $7 for the first 10 services each calendar year, a total of $70.

    I thought everyone was capped at $70 per year… oh, well that shows how closely I’ve been listening.

  15. MartinH

    just had his prostrate whipped out privately – he was still 5k out of pocket despite, having paid into PHI for at least 30 years, and as a SFR he pays the medicare levy.

    As an anaesthetist there are funds which rebate $50 before tax and expenses for a one-hour prostate resection, including spinal anaesthesia and sedation. Medicare pay more but not a great deal, hence the gap.

  16. amortiser

    It is astonishing that the government has been allowed to take over the provision of health services. In debating this issue I put it to people would they be happy for the government to take over the servicing of their motor vehicles. How long do you think you would have to wait to get your vehicle repaired or serviced if it were bureaucrats controlling the funding?

    As far as numbers’ nonsensical comment about the market providing health services, he is free to help anyone who cannot help themselves. The market exists whether it is convenient or not. The very fact that there are long waiting lists under existing arrangements shows the existence of the market. In the absence of a transparent price mechanism the price people pay for free health care is long queues.

  17. MartinH

    In the absence of a transparent price mechanism the price people pay for free health care is long queues.

    When you are in the middle of it it gets even stranger. There are people who can barely see, who have been on cataract waiting lists for literally years, they haven’t been able to read a book or do anything. Some of them have to be prodded to consider the possibility of just paying for it themselves if they can scrape it together or work out an instalment arrangement.

  18. MartinH

    Which visits? Specify please.

    Sick certificates for single-day absences
    All visits for coughs and colds in otherwise healthy adults
    Routine vaccinations
    All visits for ‘repeat prescriptions’ in the absence of clinical change

    That would be a start

  19. kevin

    Boy, you can sure tell which people posting here work for the health industry!

  20. kevin

    As an aside, I am sorry I can’t give my vote to David Leyonhjelm. He talks great sense.Perhaps he could relocate to my neck of the woods

  21. .

    eg stepdad(80) just had his prostrate whipped out privately – he was still 5k out of pocket despite, having paid into PHI for at least 30 years, and as a SFR he pays the medicare levy.

    What a rip off. Socialised medicine punishes the elderly.

  22. Peter

    One of DL’s better efforts.

    I am still waiting for him to develop an articulate, attractive encapsulation of the benefits of Libertarianism.

    It needs to be more than just a trite slogan, but short enough to be genuinely memorable and repeatable. In an article like this, intermingled with detail, it is not so easy to extract or use to convinc others. It should answer two questions.

    - How does it benefit me?
    - How does it benefit those I care about ( whether that is my family, my social group, the poor or the environment )?

    Until he can do that, he will not change the culture sufficiently to make Libertarianism popular.

  23. Demosthenes

    There are people who can barely see, who have been on cataract waiting lists for literally years, they haven’t been able to read a book or do anything.

    That’s not good. Is it always an elective procedure, even when that advanced?

  24. .

    So health, according to your glib ideology, is a market?

    Goods and services are exchanged for something else of value.

    What do you propose we call it? Catallaxy? Meerkat?

    Please don’t educate children beyond arithmetic and basic English language skills. You are not qualified to go any further.

  25. .

    - How does it benefit me?
    - How does it benefit those I care about ( whether that is my family, my social group, the poor or the environment )?

    If you don’t know, you’re not an adult.

    The elitism shown by subsidised socialists in eschewing freedom as “redneck’ etc is another form of emotional retardation, along with a lack of wisdom and speaks volumes for the lack of their own creative thinking.

  26. Sick certificates for single-day absences
    All visits for coughs and colds in otherwise healthy adults
    Routine vaccinations
    All visits for ‘repeat prescriptions’ in the absence of clinical change

    Really interesting.
    When I was a school principal many of the students at my special school were in poor health, and extremely difficult to care for if they caught a common or garden variety virus. In some cases one parent of such a child would have to stay home to care for the sick child, who ususally took much longer to recover than an able-bodied child.
    This resulted in loss of productivity for the employer of the carer concerned, and loss of wages for that same carer.
    The object, then, was to decrease the incidence of viral infection in the school population, both staff and students.
    Over a period of three years, we were able to do this by between 30 and 40 percent, as measured by the combination of staff and student absences due to illness.
    One vital component of our strategy (which included compulsory annual flu injections for staff, and disciplined hygiene practices – hand washing etc) was teachers and aides absenting themselves from work if they knew or believed they were infectious.
    This of course meant a visit to a GP to get a health certificate – one of the reasons you cite as calling a visit “unnecessary”.
    This is just example of how the visits to the doctor which you describe as unnecessary actually save the health system.
    Ever calculated the cost to the health system of an emergency hospitalization and treatment of a person with a disability in severe respiratory distress?

    All visits for ‘repeat prescriptions’ in the absence of clinical change

    This is also interesting.
    A person on say, blood pressure medication needs to revisit a GP to have his/her prescription renewed usually on a bi-monthly basis.
    Should this person not visit the GP “in the absence of clinical changes”, cease to take the medication, and take the risk of a stroke and death or expensive medical treatment and rehabilitation post episode?
    You make no sense at all.

  27. sceptic

    Sick certificates for single-day absences
    All visits for coughs and colds in otherwise healthy adults
    Routine vaccinations
    All visits for ‘repeat prescriptions’ in the absence of clinical change

    Agreed to all, as a full time GP.

    This of course meant a visit to a GP to get a health certificate – one of the reasons you cite as calling a visit “unnecessary”.

    This is unnecessary. The GP has not done anything clinical, and have been paid as a clinician for doing administrative work. A simple note from the parents should suffice. Anything else is bureaucracy and BS.

    Ever calculated the cost to the health system of an emergency hospitalization and treatment of a person with a disability in severe respiratory distress?

    Strawman argument. If a child, or anyone else, is actually ill – than this is, by definition, a necessary visit. No-one is advocating that these people should not visit the doctor.

    All visits for ‘repeat prescriptions’ in the absence of clinical change

    A person on say, blood pressure medication needs to revisit a GP to have his/her prescription renewed usually on a bi-monthly basis.

    Rubbish. You mean twice a year. Not only is this six times less than you suggest, anyone with clincial hypertension meets the criteria of having a chronic disease and can be managed using the chronic disease item numbers, which are exempt from the co-payment. Anyone who needs to be seen more often than this is a necessary and non-standard consultation.

    I might add, a lot of doctors are complaining that they would, under the mooted changes, not be free to charge or not charge as they see fit. What they actually mean is that they would not be able to provide clinically useless services to patients, free to the patients, but expensive to the taxpayer. Any doctor is free to discount their services to those for whom they deem it appropriate. I do that for my patients who cannot pay. I charge a private fee for those who can pay. I then have to provide them the added value that makes it worthwhile to them to pay that fee.

    That’s a market.

  28. .

    Maybe they should lose some weight?

  29. rebel with cause

    Should this person not visit the GP “in the absence of clinical changes”, cease to take the medication, and take the risk of a stroke and death or expensive medical treatment and rehabilitation post episode?

    If they are so thickheaded that they cease to take medication they need in the absence of a monthly chit-chat with their GP then they weren’t long for the world anyway.

  30. Demosthenes

    Tell me how that works for one of my clients – a seventeen year-old Aboriginal girl with severe and multiple impairments living in a remote town in South-Western Queensland.

    Short term, it sounds like a candidate for government assistance to move closer to the necessary services. The policies that encourage communities to sit in shitholes for ‘cultural’ reasons are the primary cause of the gap your students are taught to worry about.

    In the long term, structural reform discussion in serious policy circles often includes pro-market ideas with identifiably libertarian rationales. Things like decentralisation, regional models to suit local needs, shifting away from ever more specialised and expensive doctors and their artificially restricted supply, making the system paying-patient-centred rather than doctor-remuneration-centred, getting rid of federal government duplication, increasing accountability, and minimising perverse incentives.

  31. Token

    There are people who can barely see, who have been on cataract waiting lists for literally years, they haven’t been able to read a book or do anything.

    Great example of how public health fails vulnerable people.

    Cataract correction is such a cheap & quick procedure. My wife performed many such corrections in India during her uni years as she sought to become a qualified optom.

  32. Boambee John

    On the subject of “social” visits to the doctor, I suspect that they would be cheaper than allowing the old and lonely to fall into the parasitical hands of the “social workers”. (Track down and listen to the song from West Side Story, way back in the 1960s, to hear a brutally accurate opinion of social workers.)

  33. .

    Very well articulated, Demos.

    I am sure that in a public debate, your reason would sway the audience away from numbers silly sensationalist squealing.

    I still say if you’re gonna kick the bucket without seeing the doc for a monthly visit due to hypertension – you really ought to consider the Cambridge diet or similar such as another protein sparing modified fast/very low calorie diet:

    http://en.wikipedia.org/wiki/The_Cambridge_Diet

    That is, fatties should lose some weight, and not be pimped out by the AMA to buy another BMW.

  34. MartinH

    This of course meant a visit to a GP to get a health certificate – one of the reasons you cite as calling a visit “unnecessary”.

    It makes no sense for the GP to do this, limited absences should be a contractual issue between employer and employee.

    Ever calculated the cost to the health system of an emergency hospitalization and treatment of a person with a disability in severe respiratory distress?

    Tenuous connection between a sore throat, viral symptoms in a healthy adult and severe respiratory distress.

    A person on say, blood pressure medication needs to revisit a GP to have his/her prescription renewed usually on a bi-monthly basis.

    It’s not 1800. They can check it themselves at home, go to the pharmacist and if you want to go high tech the readings could be flagged via an app and emailed to the GP if they go off. I have a chronic medical condition myself. Once it is diagnosed, treated and stable, and the medication dose is effective and well-tolerated, I don’t need to waste anyone’s time talking about it.

    From the reply by sceptic:

    I might add, a lot of doctors are complaining…
    any doctor is free to discount their services to those for whom they deem it appropriate. I do that for my patients who cannot pay. I charge a private fee for those who can pay. I then have to provide them the added value that makes it worthwhile to them to pay that fee.

    As I have said elsewhere, this co-payment is purely a unilateral reduction in the Medicare rebate. The Govt is playing chicken with the doctors. They know that the reason I bulk bill some of my patients is that they are hopelessly insolvent, or are infirm pensioners, and that I know that any out of pocket charge will be too difficult to collect and not worth it with a Medicare rebate anyway. They know that we will continue to bulk bill these patients at the lower rate and keep charging the same amounts to the guys being charged already.

    As is no secret, medicare rebates have been frozen and will have stayed at the same nominal value for four consecutive years. In my specialty they have halved in real terms since Medicare was invented, and are approaching irrelevance really.

  35. MartinH

    There are people who can barely see, who have been on cataract waiting lists for literally years, they haven’t been able to read a book or do anything.

    That’s not good. Is it always an elective procedure, even when that advanced?

    Once someone is so impaired that it is dangerous, it would be a Category 1 procedure (less than 30 days) in theory but the actual time taken in practice is a different matter. If you aren’t that bad, but get frustrated and exhausted trying to read the newspaper or your favourite TV program and end up angry and depressed, that kind of thing doesn’t as far as I am aware change your priority on a public list. Socialist health only measures how many cataracts are done and how much it costs to do them.

    Don’t forget that elderly people in horrible pain wait years for knee replacements under our system, while we have enough cash to pay for healthy people to see GPs with their runny noses, or to start vague future ‘research funds’, and to subsidise private health funds to pay for mystic alternative therapies.

  36. Boambee John

    “This of course meant a visit to a GP to get a health certificate – one of the reasons you cite as calling a visit “unnecessary”.”

    Our local pharmacy now offers this service, I’d be surprised if it was the only one to do so.

  37. rebel with cause

    Someone who gets upset about paying $7 to visit a doctor simply does not recognise that a doctor’s time is valuable.

    Socialist medicine robs us of the capacity to value our doctor. But it also devalues the patient. I’m happy to pay to ensure that when I’m sick I’m more than just a Medicare item number.

  38. MartinH

    Our local pharmacy now offers this service, I’d be surprised if it was the only one to do so.

    It is by definition pointless because one is paying someone else to write down how one states one is feeling. It is still a destruction of wealth whoever acts their part in the charade.

  39. Demosthenes

    Socialist health only measures how many cataracts are done and how much it costs to do them.

    That’s the first time I’ve seen someone complain that socialism only cares about the bottom line :-) It’s also one of the rare times on this blog someone acknowledges costs that can’t be captured in a ledger.

    If you don’t mind me questioning you further while you’re in the mood, and if you know the answer, what does private cataract surgery cost?

  40. A simple note from the parents should suffice.

    Very few teachers that have worked on my staff need permission from their parents to visit the GP.

    Tenuous connection between a sore throat, viral symptoms in a healthy adult and severe respiratory distress.

    If you are indeed a practicing GP (as is my brother) you exhibit an attitude towards people with disabilities which is unfortunately relatively common. Your profession can’t “cure” disabilities, so generally washes their hands of this group. I’m not talking about a healthy adult.

    I don’t need to waste anyone’s time talking about it.

    An elderly relative of my acquaintance visit his GP every month to have blood pressure medication reviewed. I doubt very much, given he has a very full and engaged existence, that he does it so he can have a chat. In fact, he is always complaining about his “bloody GP”.
    There seems to be a disconnect between what you describe and the lived reality. Mind you, that’s generally consistent on Catallaxy.

    The Govt is playing chicken with the doctors.

    About bloody time somebody did. The medical profession’s union (AMA) has power disproportionate to their community contribution, and is far more powerful than any industrial union.

  41. DaveA

    Don’t agree:
    1. People are often stupid, uninformed – gullible.
    2. Charity is often a rort.
    3. Volunteerism is ruled by populism not need.

    Case in point: How much money raised on the pretense of medical purpose is simply used to Raise Awareness TM?

    Look how much goes to breast cancer (^ and pissed up wall) because BC is sold as a woman’s, even feminist, cause?

    Too bad if you have ass cancer because no one likes asses.

    Private will work where profit incentive applies, otherwise we need a more focused approach than volunteerism provides.

  42. sceptic

    1735099 – are you being deliberately daft?

    A simple note from the parents should suffice.

    Very few teachers that have worked on my staff need permission from their parents to visit the GP.

    The note from the parents is to say their child is unwell. For one day they can rest at home, untroubled by micromanaging salaried bureaucrats like you. If the parents think their child is unwell, then by all means come in. They shouldn’t be coming in JUST to get a note for you.

    Tenuous connection between a sore throat, viral symptoms in a healthy adult and severe respiratory distress.

    If you are indeed a practicing GP (as is my brother) you exhibit an attitude towards people with disabilities which is unfortunately relatively common. Your profession can’t “cure” disabilities, so generally washes their hands of this group. I’m not talking about a healthy adult.

    I look after a lot of people with disabilities. Sadly they see more people like you than they should. They need practical assistance to add quality to their lives, not to have clinicians ticking boxes to keep you employed. Again, if they, their families, or their carers feel that they are ill, they see me or I go to them – the interaction is not for the benefit of additional paperwork. Also, they all have chronic diseases and the visits associated with these are exempt from any mooted co-payment.

    An elderly relative of my acquaintance visit his GP every month to have blood pressure medication reviewed. I doubt very much, given he has a very full and engaged existence, that he does it so he can have a chat. In fact, he is always complaining about his “bloody GP”.
    There seems to be a disconnect between what you describe and the lived reality. Mind you, that’s generally consistent on Catallaxy.

    I suspect if he had to pay for this service, he would (if he actually exists) expect some value to be added at each consultation, or be given some advice on self management to reduce his visit frequency.

    The Govt is playing chicken with the doctors.

    About bloody time somebody did. The medical profession’s union (AMA) has power disproportionate to their community contribution, and is far more powerful than any industrial union.

    Complaining about the disproportionate power of a minority group on majority policy? ACOSS, Greenpeace, The Greens, and PUP have you firmly in their sights.

    I’d be very happy to utilise my nurse more to see patients at a lower cost to the taxpayer, for a multitude of clinical issues. Medicare doesn’t recognise this on any other basis than block funding.

    I’d tell you to stick to the classroom, but you’re doing less damage here than you undoubtedly do there.

  43. Senile Old Guy

    Nowhere in DL’s post did I see any comment on the existing Medicare Levy. As Diogenes notes, people paying the levy already fund part of the cost of care, and those who also have private health insurance still subsidize those who don’t.

    DL:

    And the mindset that good health hinges on the services of doctors rather than exercise, nutrition, sleep, social networks and low stress is a harmful mindset of dependency that free consultations only serve to reinforce.

    As a cartoon character frequently exclaimed: What a maroon!

    Cataracts have been mentioned. How does one avoid them? What about various other chronic conditions which reduce a person’s ability to exercise? I’m also wondering how people in inherently stressful occupations lead a “low stress” lifestyle.

  44. Senile Old Guy

    The note from the parents is to say their child is unwell. For one day they can rest at home, untroubled by micromanaging salaried bureaucrats like you. If the parents think their child is unwell, then by all means come in. They shouldn’t be coming in JUST to get a note for you.

    It helps if you read what numbers wrote. The note is for a staff member to stay away to avoid infecting others. Under an EBA you may get a small number of sick days which are certificate free but after that you have to go to the GP.

  45. Alexis

    About bloody time somebody did. The medical profession’s union (AMA) has power disproportionate to their community contribution, and is far more powerful than any industrial union.</blockquote
    I'm not a member. Don't want to pay for people to lobby for higher taxes. Plus the AMA aren't my union, I'm a private practitioner and not allowed to bargain collectively. My patients pay a market rate and rarely show any dissatisfaction with my prices.

  46. Alexis

    It helps if you read what numbers wrote. The note is for a staff member to stay away to avoid infecting others.

    What rubbish. If they have a cold they should stay home and the GP note proves nothing. Medical training adds no specificity to diagnosing a cold or relying on the patient’a story. Plus if they are acutely unwell with an infective illness that can’t be cured, they shouldn’t be in a doctors waiting room amongst vulnerable people (for no purpose). They should stay home and recover.

  47. Alexis

    If you don’t mind me questioning you further while you’re in the mood, and if you know the answer, what does private cataract surgery cost?

    If you are insured $0-$1000 perhaps. But the sky is the limit with some specialists and more expensive is not necessarily better. Uninsured $0 (unlikely) to $1500 for the surgeon, $0 to around $500 for the anaesthetic, $1000 for the hospital? That’s a ballpark range. But if you are desperate, on the DSP and want to pay the doctors would possibly discount and accept a payment plan, I am always happy to encourage uninsured patients.

  48. Senile Old Guy

    What rubbish. If they have a cold they should stay home and the GP note proves nothing.

    The GP note is required by the employer to claim sick leave which is allowed under the EBA. Having had more than my fair share of misdiagnoses*, I don’t especially trust GPs to get it right but I still need the f*cking note for my employer.

    * Not a general criticism of GPs as those I have seen have generally been excellent.

  49. rebel with cause

    Under an EBA you may get a small number of sick days which are certificate free but after that you have to go to the GP.

    So taxpayers are subsidising the validation of employee sickness for the employer. This should be a private matter.

  50. Senile Old Guy

    Uninsured $0 (unlikely) to $1500 for the surgeon, $0 to around $500 for the anaesthetic, $1000 for the hospital.

    How does that add up to $0 – $1000? It is actually $0 – $2000, with the latter being closer in my experience.

  51. sabrina

    Alexis – what should be the market rate for a 10-minute consultation superficial examination of a swollen knee following a minor fall, no excruciating pain, prescribe paracetamol and refer for an X-ray from a provider whose forms exist in your surgery?

  52. Demosthenes

    1. People are often stupid, uninformed – gullible.
    2. Charity is often a rort.
    3. Volunteerism is ruled by populism not need.

    All systems have their problems. Private charity can be inconsistent or sporadic, subject to donor fatigue, aimed at causes du jour, unevenly spread or insufficient, tied to religion or ideology (which means certain people get help and others don’t), and less likely to be accepted by the needy due to feelings of pride. The cradle-to-grave welfare state is a massive over-reaction to these real but manageable problems.

  53. Senile Old Guy

    So taxpayers are subsidising the validation of employee sickness for the employer. This should be a private matter.

    Perhaps it should…but, currently, it isn’t. Note, employers may differ in their practice, as will entitlements under EBA.

  54. 1735099 – are you being deliberately daft?

    No – you can’t read.
    If you scroll up, you’ll note that it was the teachers requiring the medical certificate, not the students.
    You seem to have ignored that twice.
    My point is, that if staff are infectious, they should not be at work.
    Clearly, you have little experience at supporting patients with disabilities in institutions.
    A school for students with disabilities has a range of characteristics not found in a regular school setting. These include frequent and constant physical contact between staff and students, required if a viable learning program is in place, and the sharing of all kinds of orthotic and therapeutic equipment.
    Combined with the fact that these children often have compromised immune systems, as a result of physical immobility, the rate of infections is generally higher than in a regular setting.

    For one day they can rest at home, untroubled by micromanaging salaried bureaucrats like you.

    That is gratuitous and indicates that your ideology gets in the way of your medical practice. I am not a bureaucrat. In a previous life, I did for a short time work in regional administration, and I can assure you that the level of bureaucracy evident there was small beer compared to what passes for administration in the private health system.

    The difference is that at every stage in the private system, someone puts their hand out for a dollar. It resembles an endless gravy train of ticket punchers.

    We don’t work like that in the education system. Occasionally we ask for a diagnosis from say a pediatrician or an orthopedic surgeon. This is often granted with great reluctance, using privacy laws and whatever else to block attempts to garner additional support at school level for the student.

    The worst I’ve seen is a form signed by an orthopedic specialist asked to confirm a diagnosis of ideopathic juvenile arthritis. He scrawled “There is nothing wrong with this child” on the form he was asked to sign.

    We went to another othopod who signed off on the form, noting that the first specialist had an ideological objection to additional support for students with disabilities.
    This revealed both the arrogance and ignorance of this highly paid individual who was simply asked to diagnose, and took it upon himself to make a political statement to the detriment of one of his patients.

    Stick to your knitting. You know nothing about education.

  55. rebel with cause

    The point is that the medical certificate serves no medical purpose. The reason some employers ask for them is that they slightly increase the cost of a sick day to the employee (they have to organise a doctors visit) thereby reducing the number of sick days overall.

  56. Diogenes

    A school for students with disabilities has a range of characteristics not found in a regular school setting. These include frequent and constant physical contact between staff and students, required if a viable learning program is in place, and the sharing of all kinds of orthotic and therapeutic equipment.
    Combined with the fact that these children often have compromised immune systems, as a result of physical immobility, the rate of infections is generally higher than in a regular setting.

    Amen numbers.
    Late No2 son nearly died as a result of chickenpox 3 years before he eventually did (next monday 14 years ago). That particular episode left him no longer able to stand as it caused damage somewhere between the brain and the ankle – over the 2 week period of his hospitalisation his left foot pointed down 45deg and was rotated through almost 90degree (neatly dislocating it) because 1 @!%!#&^ came to work when their child had chickenpox it cost the medical system @6k for the bed + a wheelchair. It cost us a wheelchair enabled vehicle, renovations to our bathroom so that he could get his chair into it. There were numerous other “petty cash” expenses (such as paying for no1 son to go into OSHC as Mrs D was at the hospital) and the new ongoing expense of pain killers, physio and attempts to “unlock” the muscle using Botox- all up I would rather have paid for that !~@#$ the $50 to get a certificate than the 30-40k it ended up costing me & your share the wheelchair and hospital expenses.

    One man’s terrorist etc etc suitably adjusted for unnecessary visit

  57. Diogenes

    However I will say the system is designed to be ridiculous…

    No2 son’s was genetic & incurable, yet every year we had to troop down to the GP to get a new referral to see the Genetic Specialist, Neurologist, Orthopaedic specialist, Paediatrician and ENT. Every 2 years we had to see all these ladies and gentlemen to complete the appropriate paperwork for Centrelink to receive a Carers Allowance (then worth about @ 25 a week). Every year we had to get new paperwork from specialists for his school IEP (so that he could remain enrolled at the Special School) and after every every “major” hospitalisation (such as the one described above) the IEP & Care Plan would need to be redone (an episode with a cold saw his swallow impaired & he required feeding through a gastrostomy ).

  58. .

    Stick to your knitting. You know nothing about education.

    Who taught us?

    The worst I’ve seen is a form signed by an orthopedic specialist asked to confirm a diagnosis of ideopathic juvenile arthritis. He scrawled “There is nothing wrong with this child” on the form he was asked to sign.

    Shut up. You know nothing about medicine.

  59. However I will say the system is designed to be ridiculous…

    It is.
    If the NBN does nothing else it needs to bash the bureaucratic heads of the medical and educational systems together so they come up with something seamless that renders this ritualized nonsense unnecessary.

    Every time the politicians get into “blame the victim” mode, the bureaucracy goes into overdrive as a response to the alleged “tightening up” of eligibility.

    The most egregious examples I have seen of this occurred during the term of the Howard government when parents of offspring over 16 were sent back to the specialists to confirm diagnoses of (amongst other thing) Downs Syndrome and Cerebral Palsy. It seemed lost on the ideological fanatics that these were lifelong conditions.

    We are, I’m afraid (with the current hoopla about DSP recipients) about to see a rerun.

  60. .

    I really see the need to ignore numbers

    A serial liar bullshitting about many unrelated topics at the same time. The NBN will be good for us because it will “bash bureaucratic heads”.

    You wouldn’t read more asinine drivel in Pravda.

  61. Token

    That’s the first time I’ve seen someone complain that socialism only cares about the bottom line It’s also one of the rare times on this blog someone acknowledges costs that can’t be captured in a ledger.

    You think you are being clever, not a surpise.

    We all know how education, childcare and many other services under our big government approach sees costs blow out due to over-regulation and protection of union workers while service levels are ignored.

    Do you know the difference between cost and value?

  62. Senile Old Guy

    The worst I’ve seen is a form signed by an orthopedic specialist asked to confirm a diagnosis of ideopathic juvenile arthritis. He scrawled “There is nothing wrong with this child” on the form he was asked to sign.

    Shut up. You know nothing about medicine.

    Another carefully argued response from dot. /sarc

    I believe number’s story but will point out that people in the education system have been known to do similar.

  63. Token

    If you don’t mind me questioning you further while you’re in the mood, and if you know the answer, what does private cataract surgery cost?

    Oh Demo, you are playing that old game. Find an issue and drill down.

    Why don’t you go out and find it for us all? Also find out for us what are the rules in Australia surrounding the procedure and compare to other juristictions.

  64. .

    Another carefully argued response from dot. /sarc

    It was, if you read the fucking thread, now stop being a feckless idiot, giving numbers more credit than a broken down drunk at the TAB.

    He is a disgusting serial liar.

  65. It’s also one of the rare times on this blog someone acknowledges costs that can’t be captured in a ledger.

    Every now and again, somebody posts a rare gem here.

    Not everything that counts can be counted, and not everything that can be counted counts.

    This means much the same, and has been attributed to Einstein.
    In fact, it comes from William Bruce Cameron, a sociologist.
    Nothing so truthfully profound would ever be generated by an economist.
    As a discipline, they rarely advance beyond counting, and then they often get it wrong………….

  66. .

    Nothing so truthfully profound would ever be generated by an economist.

    This fallacious nonsense just shows you for the ignorant, ill-read, tribalist, political hypocrite and bigot you are.

  67. alexis

    Uninsured $0 (unlikely) to $1500 for the surgeon, $0 to around $500 for the anaesthetic, $1000 for the hospital.

    How does that add up to $0 – $1000? It is actually $0 – $2000, with the latter being closer in my experience.

    I’m not sure what you mean but I mean the hospital is an extra expense as you pay the hospital itself for a day presentation. So the total could easily be up to $4000. Hopefully not. My understanding is that in some circumstances private surgeons use spare public facilities which ends up cheaper although it may take a bit longer to get a booking.

    Alexis – what should be the market rate for a 10-minute consultation superficial examination of a swollen knee following a minor fall, no excruciating pain, prescribe paracetamol and refer for an X-ray from a provider whose forms exist in your surgery

    It’s not my field so I wouldn’t want to judge, but $50 for a GP consultation would probably be average in a fancy suburb for a non-bulk-billing clinic.

  68. alexis

    “Tenuous connection between a sore throat, viral symptoms in a healthy adult and severe respiratory distress.”

    If you are indeed a practicing GP (as is my brother) you exhibit an attitude towards people with disabilities which is unfortunately relatively common. Your profession can’t “cure” disabilities, so generally washes their hands of this group. I’m not talking about a healthy adult.

    Uhh..I think you have the attitude problem. I have an incurable disability myself, and work with ‘this group’ all the time as well.
    As has been explained multiple times, people with lifelong disabilities are covered under separate item numbers and are a different issue. What I am referring to as I have made very clear is that in healthy adults there is no need to see any doctor for a runny nose and sore throat. If you disagree with that specific point please explain why. It is significant as so much of the health dollar is expended in ways like this.

  69. Aristogeiton

    Senile Old Guy
    #1428764, posted on August 25, 2014 at 12:08 pm
    Nowhere in DL’s post did I see any comment on the existing Medicare Levy. As Diogenes notes, people paying the levy already fund part of the cost of care, and those who also have private health insurance still subsidize those who don’t.

    It’s just another tax. It funds government, nothing more. David released an alternative budget; you should check that out if you haven’t already.

  70. Aristogeiton

    1735099
    #1428961, posted on August 25, 2014 at 2:58 pm
    [...]
    As a discipline, they rarely advance beyond counting, and then they often get it wrong………

    You, on the other hand, always get it wrong.

  71. Demosthenes

    Oh Demo, you are playing that old game.

    Engaging civilly with people who do the same? Informing myself before coming to a position? Well, yes, I guess I am. Give it a go sometime.

  72. My Quadrant article is better.

    Naturally.

    For example, I see not one reference in Senator Leyonhjelm’s piece to pinatas.

    Understand this, and you understand all.

  73. bemused

    I’ll believe in charities when they are as accountable and open to scrutiny as corporations. What do they fear?

  74. stackja

    In that world the most needy would receive all the support they required, and private support for medical research would not be discouraged.
    David Leyonhjelm is the Liberal Democrats’ Senator for NSW.

    Since David was born April 1, 1952, now age 62, he may have forgotten the pre-Medibank health scheme.
    Again the ALP is to blame for “An Unhealthy Approach to Health”.
    When the ALP is abolished I look forward to “An healthy Approach to Health” in the mean time keep dreaming.

  75. sabrina

    Thanks Alexis, I was charged $62, out of pocket by $25 at a inner city clinic, at a short notice, so it is in the ballpark.

  76. stackja

    Liberty Quotes
    [Wayne] Swan is a hard worker and spends a lot of time poring over briefs
    — Judith Sloan

    The great unwashed?

  77. motherhubbard'sdog

    sabrina, in Canberra you could expect to pay at least $70. You did well.

  78. wreckage

    So health, according to your glib ideology, is a market?
    Tell me how that works for one of my clients – a seventeen year-old Aboriginal girl with severe and multiple impairments living in a remote town in South-Western Queensland.

    He told you that, you incurable fucktard. The less government money that goes on middle class nitwits getting a grease and oil check for free, the more there is for people who need help.

  79. wreckage

    Not everything that counts can be counted, and not everything that can be counted counts.

    Yeah! FUCK SCIENCE! What has rational consideration of plain facts ever done for us?

  80. wreckage

    “the things of this world cannot be made known without a knowledge of mathematics.”

    Roger Bacon

  81. Alain

    Did someone seriously suggest seeing their nurse instead? Take one look at the ATAR cut off for nursing degrees and the calibre of bitchy screamining socialist unionist feminazis who do the course and you will realise its a terrible idea.

  82. wreckage

    Did someone seriously suggest seeing their nurse instead?

    Yep. If all you need is a thermometer reading and a dose of salts a nurse is well qualified to give it to you.

  83. .

    The false demarcation between what doctors and nurses can do pushes up costs. In the US, it accounts for around 17% of the costs of healthcare.

    Most of your care in a hospital is from nurses, even intervention. Doctors and managers and analysts generally, unless they are surgeons.

    There is no reason why this shouldn’t occur in general practice from more nurse practitioners.

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