Published in Age on Friday, March 6, 2015

Whilst the suggestion that the Medicare levy should be increased to fund more spending on Medicare is better than charging co-payments it still hits low income workers more than the rich (Increase the levy but don’t mess with Medicare”, Editorial 5/3). Whilst is progressive in the sense that the more one earns, the more one pays, it remains a flat percentage of income. That is regressive. Two percent of $300,000 means much less than 2% of $30,000 because of the enormous discretionary income for someone on $300,000. That’s why we have tax brackets, to make income tax more progressive.

Medicare is expensive. But it is sustainable if the money currently spent was spent more efficiently. There are many suggestions as to how to make it more efficient which the Federal Government has so far largely ignored. We could for example pay world market prices for prescription drugs rather than paying ten times the market price as we do for cholesterol lowering, the statins. That could save $1 billion per year.

If more money is needed why not just get it from general taxes or all the tax evaders?

Tim Woodruff

vice president

The federal government’s temporary funding bailout for CoHealth (Community Health Centre Stays Open 20/11) is welcome but it ignores the major structural issue of funding for the care of our most vulnerable patients. A GP treating a Brighton billionaire for complex disease receives as much as a GP caring for a patient with similar disease who doesn’t speak English, has minimal understanding of health and disease, is from a different culture, and feels isolated in a strange country. It is 4 years since we suggested to Minister Butler that adjusting GP payments to take account of socio-economic status is feasible and fair. Nothing we have heard to date suggests that such changes will occur, despite the fact that morbidity and mortality clearly correlate with such status.

One hundred and twelve deaths from Covid in a week in Victoria and not a squeak from our politicians (Sunday Age 18/6). No press conference to encourage mask wearing especially in indoor crowded places and public transport, to once again explain that if it’s 6 months since your last vaccination or infection you should have another vaccination, and no encouragement to have HEPA filters in indoor spaces.
The lowest death rate for Victoria in the last 12 months was about 20 per week in late January. Up to 10% of those infected get long Covid even with mild disease. Most deaths occur in the elderly. If the preventive measures were repeatedly encouraged the death rate might be halved. These preventable deaths are the responsibility of our politicians who refuse to lead. Their policy is ageist. Old people don’t matter. Their behaviour is morally indefensible.

We ranked No. 1 out of ten for our health care system according to the US based Commonwealth Fund (This healthy nation’s fit for a fall 2/10). The ranking was based on combining 5 different measures. On access to health care we ranked ninth, just above the USA. Somehow, despite that appalling ranking, we ranked No,1 on equity. How could that be? The measure of equity this think tank uses is obviously grossly inadequate. We are clearly not number one, as the many patients struggling to access care, will attest.

In addition, we rated No.1 on health outcomes, another of the five measures. Health outcomes are hugely determined by the social determinants of health, the conditions in which we work, live, and play. These are not part of the health system.

Let’s not kid ourselves. Our health system needs reform.

I agree with Ross Gittins (Age 1/5) that we provide quality health care as well or better than most countries but with several important caveats. Firstly, that care is not available in a timely manner to many. Access is determined by postcode, whether it is financial or geographic or cultural disadvantage. We are down the list of OECD countries when it comes to timely affordable access.

Secondly, it is optimistic to call our health care a health system. It consists of multiple silos which are often a nightmare for patients and carers to negotiate. That may be the same elsewhere, but relates to our federated system.

Thirdly, the main theme of the argument is improved productivity due to technological advances for specific ailments. That is just one part of health care. Countries with high quality primary health care (not the fancy new technology), have improved health across the socioeconomic spectrum.

We hope that the evolving approach of Labor to that issue will continue apace.

Published in The Age on Friday, January 20, 2006

KIERAN Schneemann and the pharmaceutical industry lobby group Medicines Australia (Letters, 18/1) choose to evade the influence the pharmaceutical industry has on drug policy in the US and their encroachment into policy here in Australia through the Australia-US free trade agreement.

The Pharmaceutical Benefits Scheme has traditionally had the interests of the Australian population and public health guidelines as its basis – not rewarding so-called “innovation” of the pharmaceutical industry.

Subjecting the PBS to a trade agreement has been a backward step for health policy in Australia.

Dr Tracy Schrader, national vice-president, Doctors Reform Society

Published in The Age on Tuesday, February 7, 2006

Where will the debate about waiting lists and crowded emergency departments end? It really starts in the wards of public hospitals where patients who should be in nursing homes or hostels can’t find a place, where patients who should have been managed well in their homes or nursing homes couldn’t get good primary care and became so sick they needed admission, where doctors frustrated with the poor capacity of the hospital leave for the easier and more lucrative publicly financed “private” hospitals.

If there are no beds, cancellations have to happen, and patients must wait in emergency departments on trolleys. If waiting times for surgery are over a year and multiple cancellations still happen, it’s a further blow to morale amongst staff and a further incentive to move to the taxpayer funded private system.

It won’t end until these factors are sorted, and unfortunately most of these factors are largely the responsibility of the Federal Government whose best idea to date seems to be a hotline which will not touch the problem as it only deals with minor illnesses, not the root causes of our public hospitals’ woes.

Dr Tim Woodruff
President
Doctors Reform Society

Published in The Age on Monday, February 13, 2006

Australians face an increasingly privatised two tiered health system with “safety nets” made weaker every year, a crisis in mental health, years long waiting times in public hospitals, increasing gaps between the health of the poor and the rich and patients struggling to find an affordable GP, let alone a specialist.

The $1.1 billion for health committed by federal and state leaders to address these problems is a sad indication of the priorities for health reform. It is only one tenth of the amount which will be spent propping up the private health industry over the same period.

The best they could commit to regarding the huge workforce shortage was some more full fee paying medical student places to produce doctors who aren’t good enough to qualify for HECS funded places, with no commitment to HECS places for doctors and nothing for nurses, just a commitment to talk more about it. The approach to mental health was similar, more talk.

Despite the promising federal/state cooperation, the real concern is that the states are now cooperating to pursue the federal agenda, the gradual erosion of our universally accessible and affordable health system and its replacement with a user pays, private system with targeted inadequate “safety nets”.

Dr Tim Woodruff
President
Doctors Reform Society

Published in The Age on Wednesday, March 22, 2006

Reports that universities are considering training specialists rather than leaving it to the specialist colleges is very welcome news and follows the 1994 recommendations of a report by Peter Baume, a former health minister and Liberal Party senator. In the face of continuing and increasing shortages of specialists, especially in the public system, such a move can only benefit those many Australians stranded on waiting lists throughout the country.

Dr Tim Woodruff
President
Doctors Reform Society

Published in The Age on Thursday, May 4, 2006

The nature of the inappropriate inducements for doctors mentioned by Medicines Australia (Letters 3/5), which supposedly prevent the pharmaceutical industry influencing doctors are not clearly defined by the code they have written for themselves.

The code is then interpreted by a committee dominated by the industry, with an appeals committee similarly dominated. It’s called “self-regulation” which, in the case of such a profit-driven industry as the drug industry, effectively means no regulation. The “gravy train” is set to continue unchallenged until the Federal Government steps in and regulates the industry or gives the Australian Competition and Consumer Commission the power to regulate.

Dr Tim Woodruff

President

Doctors Reform Society