Category: Health

  • Euthanasia – A denial of human dignity. Guest blogger Dr Joanne Wright

    It is concerning that The Greens and organisations such as GetUp have seen fit to re-ignite the debate about the legalisation of euthanasia.  I am a doctor.  I worked in palliative care and now work with the elderly.  I have seen first hand the complexity of the issues at the end of life. In reality, most people who say they agree with euthanasia have little understanding of the issue at all.  The term as it is intended by pro-euthanasia activists refers to the intentional termination of life by another at the request of the person who wishes to die, not the withdrawal of futile care or “life support”.

    It is ironic that those with a pro-euthanasia stance refer to euthanasia as “dying with dignity”. I don’t know what is dignified about one person intentionally killing another or providing the means for their suicide.  It must change the person who does the deed irrevocably.  On the other hand, I have seen many dignified deaths.  Dignity has nothing to do with whether a person is faecally incontinent, disfigured, emotionally disturbed or unattractive.  Dignity has to do with the respect we accord every individual, regardless of personal characteristics or their current state of health.  Accepting death when it naturally occurs is quite different to condoning or encouraging the intentional killing of or suicide by another.

    Harvey Chochinov, a Canadian psychiatrist, has written extensively about dignity at the end of life and his views are valid in this context.  He describes the all-important interpersonal dimension to dignity.  Dr Chochinov’s model affirms the basic truth that human beings are relational and that what accords us dignity is how we are treated in a relationship.  The legalisation of euthanasia alters the interpersonal relationship between the vulnerable patient and their carers.  If the patient does not volunteer to be euthanased perhaps the patient is being selfish by remaining burdensome to others.  The idea that we can prevent subtle “coercion” through legislation shows a lack of understanding of the realities and subtleties of human relationships. History has shown that the people most commonly euthanased “voluntarily” are women, the mentally ill, socially isolated and socioeconomically disadvantaged.  These are the usual victims when society fundamentally loses its respect for human life.

    Having worked in palliative care, I have had requests from relatives and carers to euthanase dying people. What was evident was that these “observers” were suffering and wanted their own suffering to end. Vulnerable and sick patients often believe that they are a burden to those around them.  So do elderly people. I hear it from them all the time. We know that suffering is a reality in life.  Palliative care and modern medicine relieve most suffering but cannot relieve all.  When carers are able to rise to the occasion with conscientious caring for a vulnerable person, the dignity of that person is affirmed.  Much anxiety in the patient is also relieved.  For those few who really do suffer extreme and unrelieved existential anxiety at the end of life, good palliative care offers the option of sedation.

    It is widely recognised that Western Society has become detached from death.  We tuck away dying people in hospices or hospitals and often don’t have effective rituals surrounding death.  We shield our children from death.  As a society, we are in “death denial”.    We have a belief that modern medicine can, or at least should, cure every ill – this is false.  If we acknowledged the certainty of death perhaps we wouldn’t be panicked into the issue of euthanasia, or into continuing with futile and uncomfortable medical treatments.  We might have conversations with our relatives about our values and the situations in which we would want treatment to be withdrawn and even draw up legally binding Advance Care Directives.

    There are times in life when we must give care – and times when we must graciously accept it.  We must not as a society define the worth of individuals by their functional abilities or level of independence.  We must not decide that the means justifies the end or that our right to make autonomous decisions trumps our instinctive understanding that it is wrong to sanction the deliberate killing of another.  If we as a society and as individuals cannot accept that at times we have to face difficulty, then we cannot face the realities of life.  We also will not foster the qualities in society that make us civilised: empathy, compassion and the protection of the most vulnerable.

    Dr Joanne Wright

     

     

     

  • Curbing health costs starting with pathologists and radiologists. John Menadue

    In discussing the looming budget deficits there has been focus on the rising costs of healthcare. And so there should be.

    But before addressing some of the factors leading to increased costs, we should keep in mind that Australia spends about 9% of GDP in health. That compares with France 12%, Germany 12%, Canada 11%, New Zealand 10% and UK 10%. The OECD median is 9%. The US at 18% of GDP is ‘off the charts largely due to private health insurance.

    Thus 9% of GDP spent on healthcare in Australia is not excessive in world terms. Medicare for all its difficulties has laid a solid basis for efficiency and equity in healthcare. We would change it at a great cost to the nation.

    I will be writing about some areas in future where cost reduction is necessary and possible e.g. the costs that are incurred because of different commonwealth and state responsibilities (e.g. patients going to an expensive Emergency Department when it would be cheaper and better to go to a GP), antiquated work practices and clinical errors.

    A central problem is that we all see our doctor too much and we have too many tests. The following table shows how all medical services per 10,000 of population have increased dramatically in the ten years to 2011/12

    These figures are derived from Medicare Australia-Statistics-Medicare Benefit (MBS) Group Statistics.

    All Medicare services by category per 10,000 of population 2001/02 to 2011/12

    Medicare service

    2001/02

    2011/12

    Increase

    % Increase
    Professional attendance

    606,240

    677,504

    71,264

    11
    Therapeutic procedures

    66,308

    88,102

    21,794

    33
    Diagnostic imaging

    63,032

    89,247

    26,215

    42
    Pathology

    336,214

    503,613

    167,399

    50
    Total

    1,090,878

    1,460,460

    369,582

    34

     

    These figures show the dramatic increase in medical services per 10,000 of population over ten years by 34%. The increase in diagnostic imaging services has been 42% and for pathology services, 50% Together with many specialists, including in church hospitals they have been making a motza..

    The government has attempted to restrain these increases particularly in imaging and pathology, but there is a long way to go. There are several reasons for the escalating number of services.

    • Advancing technology will result in more and better pathology and imaging services, for example. GP’s will naturally want to use them
    • General practitioners run more possible professional risk in ordering too few tests than too many.
    • With increasing corporate takeovers of general practice, there is more vertical integration between the general practitioner and specialist services such as pathology and imaging. There is a clear conflict of interest when a general practitioner employed by a corporate orders a battery of pathology tests from the same employer.
    • Fee-for-service is particularly inappropriate for services with high fixed costs and low variable costs, such as imaging. If fees are set on an average basis, including fixed costs, then the contribution to overheads and profits is high giving an incentive for high use. This has clearly been happening.

    There are actions that the government could take.

    It could set budgets for general practitioners when they prescribe drugs, order pathology tests or imaging services. Germany is doing some of this already to curb escalating costs.

    Improved means tested co-payments would be another way to place more financial responsibility on the patient to restrain spending

    The Government could also offer contracts to General Practises as an alternative to fee for service. It could be surprised at the take up of contracts. Many GP’s are tired of turnstile medicine. They want to work as part of a professional team with opportunities for upgrading of skills and sabbaticals. Fee for service is a driver of over servicing. It is a perverse incentive where quantity rather than quality of service is rewarded. It must change if quality of service is to be improved and costs contained.

    As in so much of health services in Australia, vested interests in such areas as imaging and pathology together with their lobbyists are very effective in protecting their interests at the expense of the patient and the taxpayer. So much of the time of the Minister and the Department of Health is taken up in managing the demands of the vested interests rather than addressing structural problems and costs in the health service. The Minister and the Department are no match for the powerful vested interests –the AMA, the Pharmacy Guild and PHI sector. It is because of the failure of existing governance of the health service – the ministerial/departmental model – that I have recommended for many years  a statutory commonwealth health commission composed of independent and professional people (like the Reserve Bank in the financial field) to administer health services in Australia, subject to guidelines determined by the government.

    An important role for such a commission would be leading an informed public debate about the changes that are necessary in health care. Without an informed community, governments are not going to have the polical courage to confront the powerful vested interests that in many respects have a veto on reform. We can’t leave it to the “market” to sort it out because there is no open or free market in health services. Outcomes are rigged by very powerful providers. They hold all the cards. It is really about power in the health sector and how that power is exercised

    There will not be effective cost containment unless this is addressed

    John Menadue

  • There’s nothing basic about basic nursing care. Guest Blogger: Professor Mary Chiarella

    The Minister for Health and Ageing, Mark Butler has announced a new aged-care workforce compact which will result in 350,000 workers receiving supplementary payments of 1% over and above award increases. This amounts to $1/hour more for each worker – the lowest paid workers in the health care industry. Why is “intimate” nursing care, for the purposes of distinguishing it from technical nursing care, identified as not needing qualified nursing staff and relegated to care workers? Furthermore these care workers, the mainstay of our nursing homes and residential aged care facilities, may only have the support of a single registered or enrolled nurse to care for as many as 60+ patients.

    Yet today the people we see in our nursing homes would have filled a medical ward in the ‘70s. There will be increasing numbers of elderly people to look after, with chronic and complex care needs, so surely there is a need to rethink and recognise the complexity of intimate nursing care and have it performed by appropriately qualified nurses? For proper remuneration? I can’t remember who said it, but the elderly are the only group against whom we discriminate to which we will eventually belong.

    This intimate nursing work, described usually as ‘basic nursing care’ is, in reality, far from basic and you need skilled nurses to perform it well. When they do, its value and necessity transcends its physical messiness. Despite what those who don’t do this work might think, it is not basic—it is extremely psychologically complex. Cleaning patients who are soiled with excreta, blood, or vomitus, who feel ashamed of themselves for being ‘dirty’ or for ‘losing control’, and restoring both their hygiene and their sense of self worth in the process, requires the highest order of skill. Nurses know its worth, yet understand society’s abhorrence of its reality.

    But the paradox is to recognise that other people simply don’t want to acknowledge the worth and complexity of the work. Better to imagine it’s “basic”. It is also a given that nurses who do this work don’t discuss it. Nurses do things to other people which have the potential to strip them of their dignity. One of the reasons why, most of the time, nurses don’t do so is because what transpires behind the screens will never be discussed in public. Good nursing care is eminently forgettable. Nurses manage to be almost ‘invisible’ as they perform the most private of functions for the patient. Listen to this description as a nurse washes a patient’s genitalia.

    Jane is looking intently at the scrotum, lifting carefully the folds to ensure a thorough wash, and painting lotion gently on the grazed area. The penis is washed with equal care and their conversation continues throughout. They could have been having this conversation in a sitting room, it is so unselfconscious[1].

    Nurses, for entirely professional reasons, don’t discuss these aspects of their work. If we did, how could the next patient feel comfortable? The view that any ‘nice’ person can deliver this kind of care diminishes the sensitivity and skill required to manage such situations.  Maybe this is partly because nurses have always done this intimate work, and usually only changes to practice are considered to deserve increased pay. But this provides an unsatisfactory model for re-assessing work value when this work was never valued originally. Furthermore the nursing management of sensitive issues of the body is not granted the same status as  – say –a psychiatrist handling sensitive issues of the mind. Because it involves manual work, ‘getting your hands dirty’, it is considered to be menial or domestic. Yet to practise such work without intellectual engagement would be crass, and could cause psychological damage. If the courts and tribunals were to value this work similarly, the entire award system would need to be revisited.

    Can we finally acknowledge how complex and difficult this work is? Let us not just admire (oh they’re wonderful –I don’t know how they do it) but also reward the people who do it with more than $1/hour. Let us recognise that intimate care of people who are old and sick (and it might be us one day) is actually extraordinarily skilful and requires a great deal of sensitivity.

     Professor Mary Chiarella

    [1] Taylor B, Being Human: Ordinariness in Nursing Churchill Livingstone: Melbourne (1994).

  • The Medicine Lobby. Vested interests win again. John Menadue

    Professor Stephen Duckett of the Grattan Institute has just reported that ‘Australians are paying too much for prescription drugs. The cost of this overpayment is at least $1.3 p.a.’

    This is another example of the power of vested interests in the health sector and their ability to extract economic rents from the community. The other privileged players in the health sector include doctors, particularly specialists, and the private health insurance industry that extracts a $3.5 billion annual subsidy from the taxpayer.

    The Minister for Health and her department spend much of their time placating and appeasing the vested interests in the health sector rather than developing policies and administering programs for the benefit of the community.

    The Pricing Authority for pharmaceuticals makes recommendations to the Minister for Health. The authority is a non-statutory body established by the Minister. Of the six members of the committee, two are industry lobbyists from Medicines Australia and the Generic Medicines Industry Authority. It is not surprising with a headstart like that that the pharmaceutical sector is able to secure the sorts of privileges that Stephen Duckett has outlined.

    The Australian Pharmacy Guild is also infamous in the privileges it extracts from Goverments. New pharmacies in urban areas must be at least 1.5 km from each other. One consequence of this restriction of competition agreed to by APG and Australian governments is that the number of community pharmacies has remained substantially unchanged at 5,000 since 1993, despite large increases in population and PBS prescriptions. The consumer organisation, Choice, in 2005 commissioned a study by the Allan Consulting Group on these location rules. Choice commented that ‘the location rules provide little consumer benefit and only advantage existing pharmacy operators’. The PGA has also successfully barred pharmacies from operating in supermarkets. Australians don’t have a great love for the Coles/Woolworths oligopoly but they would love to see more competition.

    Canberra has over 900 full time lobbyists, many in the health field. They are seriously undermining good government Their power is exaggerated but politicians fall over themselves to oblige them.

    The ministerial/departmental model in health is not serving us well. It provides a fertile hunting ground for vested interests – the health  providers- who hold all the important cards. They cling to the Department of Health like limpets. Even enquiries like the National Health and Hospital Reform Commission, are invariably timid and anxious to appease sectional interests. This Commission was chaired by a senior executive of BUPA.  After six years of the Rudd/Gillard Governments there is little to show in real health reform. The muddle continues.. But the sectional interests must be happy that their. position is secure.

    Because of the failure of health governance to counter the lobbyists and sectional interests in health, I have proposed on many occasions that the Commonwealth Government should establish a permanent, independent, professional and community-based statutory authority, an Australian Health Commission, similar to the Reserve Bank in the monetary field. The Reserve Bank’s governance structure has made it almost impervious to lobbying. It is respected for its independence and professionalism. Just as the Reserve Bank is subject to guidelines determined by the Government, so an Australian Health Commission should operate within guidelines determined by the Government.

    The power of vested interests in health must be tackled. The Grattan Report provides yet another example of why this must be done.

    John Menadue

  • Health care reform remains a prisoner of Federalism. Guest blogger: John Dwyer

    The intractable problem that sees a very wealthy country unable to provide cost effective and equitable health care is a political one. We are the only OECD country in which the provision of health care is illogically and inefficiently divided between two levels of Government. The Federal government is charged with funding, but not providing, Primary and Community care. The State governments are both funders and providers of our public hospital system and endless arguments (“the blame game”) revolve around the adequacy or otherwise of the contribution to hospital care from the Commonwealth. So 22 million people are served by nine departments of health with duplication costing us about $4 billion a year!

    Our Health system is sickness and hospital centric and unlike much of the rest of the world we have not changed our Primary care system to provide Australians with a care model that focuses on prevention. Such a system provides the “Win Win” situation where Australians would be healthier and the demand for hospital services would be reduced. The Productivity Commission reports that each year 700.000 admissions to public hospitals could be avoided by an appropriate community intervention! The States cannot pull the leavers to improve Primary Care and so relieve pressures on their hospitals and the Commonwealth seemingly does not know how to do it. The Federal government has no experience in delivering health care.  At this time when health care should be patient focussed with the spectrum of care from the doctor’s office to the hospital totally integrated (seamless) how frustrating is it that COAG has actually enshrined the separation of Primary and Community care from Hospital care?

    It’s an election year and we should again be pressuring our politicians to embrace the only solution to all this inefficiency and inequity. The Commonwealth should be the single funder of health, providing our health dollars to a single agency with appropriate expertise that would contract with various providers to deliver the required integrated system characterised by the features described above. John Menadue’s suggestion for a trial of a similar approach at State level where an agency with pooled Commonwealth and State money delivers integrated cost effective health care makes sense but even this, perhaps less difficult option politically, currently has no traction around the COAG table. The Australian public would have applauded Kevin Rudd proceeding along these lines. That same Australian public must keep such health reform strategies on the election year agenda.

    John Dwyer

     

     

  • Another misleading story about hospital costs

    The head of Ramsey Health told us in the AFR today that the “Productivity Commission report on public and private hospital systems found that the private sector was 30% more efficient”  It did not.

    Last year the CEO of the Private Hospitals Association said that private hospital costs are 32% lower than public hospitals. The same old hoary untruths keeps being repeated.
     
    The Productivity Commission concedes (p83) that it is hard to compare the costs of the two systems. However it went on to say that at a national level public and private hospitals had broadly similar cost per case mix adjusted separation in 2007/08. (Sorry for the jargon but it means comparing like with like).It added that significant differences were found in the composition of costs.
     
    Private hospitals often choose to point out that in certain areas they are cheaper. That is true for about 60% of surgery. Private hospitals are specialised in certain areas, particularly minor surgery. We have always known that the harder and more expensive work is left to public hospitals.
     
    The ultimate test of whether private hospitals are more efficient is whether they jump to treat public patients in private hospitals  on a casemix basis. The fact is they don’t. Years ago Jeff Kennett made an offer to private hospitals to treat public patients in private hospitals. They declined and despite their bravado today about being more efficient, they will still not put their misleading propaganda to the test.
     The CEO of Ramsay Health received a salary package of $ 31 m in 2014. That would partly explain why the costs of his company are so high.!
     
    I wonder if there are any scalpel sharp health correspondents who will examine the spin put out by Ramsey Healthcare?
    John Menadue


  • The blame game in health continues.

    Some weeks ago Victorian hospitals announced bed closures, job losses and elective surgery delays because of a dispute with the Commonwealth Government over the hospital funding formula. In an election year the issue seems to have been temporarily resolved by the Commonwealth stomping up more money.

    But it highlights the continuing malaise with divided. funding and operational responsibility for health care. The commonwealth has major responsibility for the Medical Benefits Scheme, the Pharmaceutical Benefits Scheme, Veterans Health and Aged care. The states run hospitals but depend on commonwealth funding to do so. Broadly, the commonwealth provides 43% of health funding in Australia, the state and local governments 26% and non-government, including individuals, 31%.
     
    The divided  funding and responsibilities was described many times as a “dogs breakfast” by Tony Abbott when he was Minister for Health.
     
    One important objective of a good health service must be to keep patients out of expensive and often forbidding large hospitals – a state responsibility. But the funding of health services to keep patients out of hospitals is largely in the commonwealth’s hands – particularly general practice and aged care. If all services were better organized in the community there would be much less pressure on the emergency departments of public hospitals.
     
    Some improvements were made by the Rudd and Gillard Governments but most of it was muddling through. Kevin Rudd suggested a referendum for the commonwealth to take over state hospitals. Opinion polls suggested the public supported doing this, but Kevin Rudd backed down. My preferred option would be for the commonwealth to take over all healthcare from the states, but I canot see any prospect of this happening politically. The states remain poor but proud.  Neither can I see the commonwealth abandoning the field to the states.  That would be disastrous!
    A practical compromise, which I proposed six years ago, would be to establish a Joint Commonwealth State Health Commission in any state where the commonwealth and the state could agree, with the commonwealth providing financial inducements for any state that would sign on. 
     
    It is envisaged that the Joint Commission would have agreed governance arrangements with dispute resolution provisions. It would have joint funding from the commonwealth and the state and would be responsible for the planning of all health services in the state. The Joint Commission would buy health services from existing suppliers – commonwealth, state, local and private.
     
    If a political agreement with one state is achieved I am confident we would see a big improvement in the cohesion and integration in health services in that state. Once the benefits in one state are secured the model could hopefully extended to other states.
     
    Unfortunately, last year the commonwealth passed up an opportunity for long term reform in Tasmania.The Tasmanian hospitals were in a financial and operational mess.The commonwealth declined to use its financial leverage and handed out more money without  reform.
     
     
    John Menadue

     

  • Corporate bullies

    Public debate and the development of good policy are being steadily corrupted by the success of powerful lobby groups to quickly close down debate and force retreat by the government. This tactic is assisted by a timid government and a media that has little understanding of policy issues, and is only too prepared to recycle the handouts from powerful groups.

    Last week we saw this bullying in full view. The government floated the suggestion that the concessions handed out to wealthy retirees in tax concessions by Peter Costello in 2007 should be reconsidered. The superannuation lobby went into immediate attack. Pauline Vamos, the CE of the Association of Superannuation Funds in Australia said that for people to have a really comfortable standard of living throughout their retirement, they should have at least $2.5 million as the balance in their superannuation account. Ian McAuley has estimated that this would give the retiree a tax-free pension of about $160,000 p.a. Such a retiree would normally not have a home mortgage and the cost of raising children and their education.  In the face of this nonsense by Pauline Vamos and others, the government quickly retreated and said that it had no intention of taxing any capital sums in superannuation. Tax avoidance won the day, quickly and comprehensively.

    In the SMH last week, Ross Gittins wrote about the ‘four industries that rule Australia’ – superannuation funds, miners, bankers and the gambling industry.  I would have added the health industry.

    In 2009, the miners ran a highly successful and cheap advertising campaign ($22 million) to defeat the Rudd Government’s resources super profits tax. They also helped to get rid of the Prime Minister! The industry saved itself an estimated $66 billion over five years. We have now been left with a wimp of a mining tax.

    In 2011, under pressure from Independent Andrew Wilkie, the government undertook to introduce strong legislation to help addicted gamblers. But the licensed clubs and the gaming industry went to work and won the day.

    Ross Gittins has pointed out that through acquisition the four major banks have increased their market share from 74% to 83%. They make record profits and continually trouser additional savings by not passing on fully to customers the cuts in official interest rates.  They ignore both the treasurer and the shadow treasurer. They have real power.

    Then there is the health lobby – the AMA, private health insurance and the Pharmacy Guild who successfully restrict competition, protect restrictive work practices or secure increased government subsidies. The public debate is about what the government needs to do to buy off the specialists, the pharmacists and the private health funds.

    The lesson is clear; the large and wealthy groups with their lobbying power can derail public debate and secure concessions for themselves at the expense of the public interest. Too often the government runs for cover at the first whiff of grapeshot.

    There is a public register that lobbyists must complete. It is quite inadequate. As a starter, the public needs to know who the lobbyists and corporations are seeing, particularly ministers, parliamentarians and senior members of the public service, together with the nature of those discussions. That information should be updated weekly. It would be a small but important step in making transparent how corruption of good policy is occurring.

    John Menadue

  • Teaching ‘medical English’ in Vietnam. Guest blogger Kerry Goulston

    Vietnamese medical students realise that English is the international language of Medicine.  They can read it well—all have Laptops or i-pads and have easy access to radio and TV- but they know that they have problems in understanding spoken English and in speaking it. It is a language very different from their own but in schools and at university English is taught by other Vietnamese. Few can afford private tuition in spoken English as they are poorly paid.  Young healthcare workers aspiring to gain scholarships overseas to further their studies realise that there is a need to improve their skills to gain acceptance in other countries. This applies to Europe, USA and of course Australia.  Australia has become a favoured country in this respect: it is much closer than the US and Europe, the time zones are similar and many Australian tourists visit Vietnam every year.
    For the last six years, twice a year, groups of Australians  have travelled to Vietnam – mainly Hanoi – to run a  four-day course in “medical” English.  Each course, managed by the education department of  a hospital, is heavily over-subscribed.   Small groups of 8-12 with two Australians teaching pronunciation, grammar,colloquialisms and medical terminology, use role-playing clinical scenarios in an interactive fashion.  Not all the teachers are  doctors — many are from other professions or are lay people.  Inn September 2012 two Australian Vietnam Vets volunteered to join the group – one had recently had a joint replacement and played the patient to the Vietnamese doctor.
    All the Vietnamese healthcare workers participate actively and feedback has been overwhelmingly positive.  Sounds of  laughter  come from each of the three rooms used concurrently – it is amazing that both Australians and Vietnamese share the same sense of humour.
    The four day course is structured so that the Australians each have 2-3 half days off to relax and see the sights.   The Australian  group is disparate  and interact among themselves at dinner and at a 4-star hotel where they all stay.

    They have the opportunity to mix socially with their Vietnamese colleagues and tour the overcrowded hospitals. This month a concurrent  session is being run by Australian nurses for Vietnamese nurses over the four days.
    Each course is fully evaluated  and the results help improve the next visit. Welcoming and closing ceremonies, presided over by the Hospital Director, involve mutual exchange of gifts and short speeches. The  two Australian Vietnam Vets gave an emotional speech thanking the Vietnamese for their warm welcome-saying “once we were enemies and it means a lot to us now to be friends”.
    All the Australians pay their own fares and accommodation. The hospitals and university provide transport, teaching venues and equipment.
    The visits allow mutual friendships to develop and are rewarding for both teachers and participants. It’s an excellent example of helping people without telling them how to run their own lives.
    Kerry Goulston, Professor Emeritus in Medicine, University of Sydney

  • Cricket – Junk food and BUPA

    I used to be a grafted-on cricket watcher. But I am being weaned off. One reason is that there is so much cricket on TV that the quality suffers.

    I mostly turn off the audio and although the camera work is superb, I can’t turn off the unhealthy diet of fast-food and beer advertisements that Channel 9 and Foxtel overwhelm me with from first ball to stumps. I thought sport had something to do with encouraging healthy lifestyles. But the endless Kentucky Fried Chicken, Macdonalds, Pizza Hut and Victorian Bitter advertisements do just the reverse.

    But my real irritation is with the BUPA ads that give me pointless information about the heart rate of players and the nonsensical suggestion that by spending money with BUPA I will  be a ‘healthier you’. Advertising by BUPA is subsidised by the Australian taxpayer. The $3.5 billion p.a. tax subsidy that the private health funds receive goes, in theory, to policy holders, but in practice to funds like BUPA. Without that taxpayer subsidy very few would buy BUPA’s products.

    BUPA boasts that it has about a 30% market share of private health insurance. With the industry subsidy totalling $3.5 billion p.a., that represents a subsidy by taxpayers of over $1 billion p.a. for BUPA.

    Like other wasteful private health funds, BUPA pretends that it offers choice, but it sells practically identical products – choice without variety. One reason why we have a relatively good and low cost health scheme is that Medicare is a strong single payer. Private health insurance has  crippled efficient and equitable healthcare in the US because private funds like BUPA do not have the power or willingness to control costs. Advertising campaigns like BUPA’s take us further down the disastrous  US path.

    BUPA  and other health insurance funds floated  ‘Medicare Select’  to the Rudd Government. This  would have encouraged  many people to opt out of Medicare. It would have been goodnight to Medicare. Companies like BUPA favour the wealthiest, they increase the usage of health services, they undermine Medicare’s ability to control costs and quality and their administrative costs are three times those of Medicare. They have not taken pressure off public hospitals. ‘Gap insurance’ provided by companies like BUPA has triggered the largest increase in specialist fees in a quarter of a century.

    As taxpayers and citizens, we should be aware of  the damage that companies like BUPA are wreaking on health services in Australia. Why should taxpayers money be used not only to disrupt my enjoyment of cricket on TV, but also to cause so much damage to health services in this country.

    Together with Ian McAuley I have written many articles on this subject. See www.johnmendue.com and click on ‘health’.

    John Menadue