A thread on politics- have some balls and post

[ZoBlitz]

 

[notliondown]

Is it wrong that I laughed out loud at that???

If only we could introduce selective smoking...

 

[notliondown]

Our biggest cost issue going forward is the sense of entitlement that seems to pervade society at the moment. I sadly have an in law that self harmed... and while that story is another issue, the cost of the treatment that she recieved - faultless by the way and anyone who complains about the medical system has never seen it at work when its desperately needed most I suspect - ran into the hundreds of thousands of dollars. Intensive care for 6 weeks at $16k a day to start with...

But what got me was the ease at which all of these services and the follow up care was just... well... taken. Not neccesarliy with any malice, but just a complete disregard for its cost or the complexity of what was going on. It was just like turning on the tap and expecting water to run out. It was there to use, so it was.

We will, sooner or later, be forced into a system that at least has some element of user pays. I have a freind who works in the E.D. of the local hospital. She talks constantly about the amount of people who go there for asprin and panadol because its cheaper than buying it. Patients calling ambulances for doctors appointments so they dont have to drive. It's mind boggling the arrogance of people at times.

And the really hard part is, its not only health, it's all govt services that get treated as charities. Education is as bad - and stupidity like Rudd giving every child a laptop simply exacerbates the issue. Its a wank, and its simply not good policy or sustainable. Policy needs to be selective and targeted. Public transport is another... it goes on and on. The short term mentality of politicians on both sides, simple encourages a belief of our "rights".

The harsh reality is that we have no stomach for the solutions. A rise to 15% for the GST is probably the best compromise (and remove some crazy loopholes) - its easy, its comprehensive, and its the best way to at least get something back from the cash-trade. Yet watch the Labor premiers run simply because of the politics of it being played out by the LNP.

If gen Y and the millennials think things are bad now, 20 years time will be awful and 50 will bear very little resemblance to day at all.

 

[carnthemlions]

Our biggest cost issue going forward is the sense of entitlement that seems to pervade society at the moment. I sadly have an in law that self harmed... and while that story is another issue, the cost of the treatment that she recieved - faultless by the way and anyone who complains about the medical system has never seen it at work when its desperately needed most I suspect - ran into the hundreds of thousands of dollars. Intensive care for 6 weeks at $16k a day to start with...

But what got me was the ease at which all of these services and the follow up care was just... well... taken. Not neccesarliy with any malice, but just a complete disregard for its cost or the complexity of what was going on. It was just like turning on the tap and expecting water to run out. It was there to use, so it was.

We will, sooner or later, be forced into a system that at least has some element of user pays. I have a freind who works in the E.D. of the local hospital. She talks constantly about the amount of people who go there for asprin and panadol because its cheaper than buying it. Patients calling ambulances for doctors appointments so they dont have to drive. It's mind boggling the arrogance of people at times.

And the really hard part is, its not only health, it's all govt services that get treated as charities. Education is as bad - and stupidity like Rudd giving every child a laptop simply exacerbates the issue. Its a wank, and its simply not good policy or sustainable. Policy needs to be selective and targeted. Public transport is another... it goes on and on. The short term mentality of politicians on both sides, simple encourages a belief of our "rights".

The harsh reality is that we have no stomach for the solutions. A rise to 15% for the GST is probably the best compromise (and remove some crazy loopholes) - its easy, its comprehensive, and its the best way to at least get something back from the cash-trade. Yet watch the Labor premiers run simply because of the politics of it being played out by the LNP.

If gen Y and the millennials think things are bad now, 20 years time will be awful and 50 will bear very little resemblance to day at all.

Why do you think essential government services exist? If we can't access a high level of health and education services regardless of our levels of income, everything else is a waste of time. Essential government services are not privileges. They're necessities.

 

[notliondown]

Why do you think essential government services exist? If we can't access a high level of health and education services regardless of our levels of income, everything else is a waste of time. Essential government services are not privileges. They're necessities.

I understand and agree completely... but if we keep going the way we are going something will have to give. Lets ask an American about access to ESSENTIAL services free of charge...

What are you/we willing to sacrifice so that the ESSENTIAL services remain viable? Because right now, some of the services provided sooner or later will have to be seen as privileges unless we find a way to balance what is seemingly a very expensive future?

 

[BRAB]

I understand and agree completely... but if we keep going the way we are going something will have to give. Lets ask an American about access to ESSENTIAL services free of charge...

What are you/we willing to sacrifice so that the ESSENTIAL services remain viable? Because right now, some of the services provided sooner or later will have to be seen as privileges unless we find a way to balance what is seemingly a very expensive future?

Can you expand on this a bit? What's inherently inefficient with the healthcare system?

Note that a sense of entitlement is intangible.

 

[carnthemlions]

I understand and agree completely... but if we keep going the way we are going something will have to give. Lets ask an American about access to ESSENTIAL services free of charge...

What are you/we willing to sacrifice so that the ESSENTIAL services remain viable? Because right now, some of the services provided sooner or later will have to be seen as privileges unless we find a way to balance what is seemingly a very expensive future?

The American political system is broken. Let's never compare ourselves with them again.

The question isn't whether governments should pay for these services. That's non-negotiable as far as I'm concerned. What we need to work out is HOW governments will continue to fund these services in the future. Unfortunately this will be more difficult due to the fact that we didn't exactly take full advantage of the opportunity presented by the mining boom. Shouldn't be disastrous if we can begin to address the revenue problem in the near future. Hopefully federal politicians will start the debate soon rather than staying quiet and just letting the states have it for them.

 

[notliondown]

Can you expand on this a bit? What's inherently inefficient with the healthcare system?

Note that a sense of entitlement is intangible.

To be honest apart from some duplication that has been slowly reduced, and just the ever increasing paper trail that seems unavoidable, I think the healthcare system in itself isn't inherently inefficient - and I don't ever think I said that. Its a massive organization (regardless of the politics of it, breaking it back down to smaller boards has seen major gains in efficiency at local levels... not all decisions are great but they at least happen fast and actions are implemented quicker with a local flavour) so it will never be a shining beacon of true recourse use - simply because demand is unpredictable, and emergencies can never wait. Staffing levels will never be right at the right time - for example... its Murphys law. So you just have to accept that a certain level of what some call "waste" exists in the system.

Its probably our use of it that's inefficient - and that's also tied into a sense of entitlement.

Why would you go to an emergency department for panadol? Or asprin? Or because you are drunk and can't find your way home? Or because the drugs you took made you think monsters were chasing you? Or to get a script filled? Or that you want to sleep off a hit or bender in a safe place with security guards, lights and air conditioning?

Why would you call an ambulance to take you to a doctors appointment? Or because you have a headache?

There has to be boundaries between what is a public service - ESSENTIAL - and self reliance and responsibility. It's hard to believe some of the stories that come out of hospitals of "patients" that steal services away from genuine cases. And in the vast majority of cases, these people are not homeless, helpless or financially unable to support themselves. They are people who believe the system is their right to use - which it is. Until they are the one genuinely in need of an emergency department bed...

You're right. A sense of entitlement is, well maybe not intangible, but its certainly flexible. What you perceive as a "right" and what others do will always vary. The balance that's very hard to gauge and is essentially a moving target, is the one between an individuals responsibility to look after themselves, efficient use of resources and the ability to support and nurture those in our society who genuinely need those services to exist.

 

[notliondown]

The American political system is broken. Let's never compare ourselves with them again.

The question isn't whether governments should pay for these services. That's non-negotiable as far as I'm concerned. What we need to work out is HOW governments will continue to fund these services in the future. Unfortunately this will be more difficult due to the fact that we didn't exactly take full advantage of the opportunity presented by the mining boom. Shouldn't be disastrous if we can begin to address the revenue problem in the near future. Hopefully federal politicians will start the debate soon rather than staying quiet and just letting the states have it for them.

Absolutely. But you could argue we more and more follow the result, if not the system itself, of American politics. This week yet again reinforces the belief of most that our Prime Minister is in fact a defacto president.

To ignore the pitfalls, mistakes and warning signs of the American system is naive and dangerous.

We crave a politician/s with balls and bravado... then vote them out. To some of us your solution is super simple and ultimately correct. Its just a shame the vast majority of disconnected and disaffected people don't seem to agree.

 

[BRAB]

To be honest apart from some duplication that has been slowly reduced, and just the ever increasing paper trail that seems unavoidable, I think the healthcare system in itself isn't inherently inefficient - and I don't ever think I said that. Its a massive organization (regardless of the politics of it, breaking it back down to smaller boards has seen major gains in efficiency at local levels... not all decisions are great but they at least happen fast and actions are implemented quicker with a local flavour) so it will never be a shining beacon of true recourse use - simply because demand is unpredictable, and emergencies can never wait. Staffing levels will never be right at the right time - for example... its Murphys law. So you just have to accept that a certain level of what some call "waste" exists in the system.

Its probably our use of it that's inefficient - and that's also tied into a sense of entitlement.

Why would you go to an emergency department for panadol? Or asprin? Or because you are drunk and can't find your way home? Or because the drugs you took made you think monsters were chasing you? Or to get a script filled? Or that you want to sleep off a hit or bender in a safe place with security guards, lights and air conditioning?

Why would you call an ambulance to take you to a doctors appointment? Or because you have a headache?

There has to be boundaries between what is a public service - ESSENTIAL - and self reliance and responsibility. It's hard to believe some of the stories that come out of hospitals of "patients" that steal services away from genuine cases. And in the very vast majority of cases, these people are not homeless, helpless or financially unable to support themselves. They are people who believe the system is their right to use - which it is. Until they are the one genuinely in need of an emergency department bed...

You're right. A sense of entitlement is, well maybe not intangible, but its certainly flexible. What you perceive as a "right" and what others do will always vary. The balance that's very hard to gauge and is essentially a moving target, is the one between an individuals responsibility to look after themselves, efficient use of resources and the ability to support and nurture those in our society who genuinely need those services to exist.

Bolded is what I'm focusing on, to tell you the truth, total garbage.

What you described is so rare (except the drugs thing).

 

[whatboutbob]

Bolded is what I'm focusing on, to tell you the truth, total garbage.

What you described is so rare (except the drugs thing).

And, yanno, triage.

 

[notliondown]

Bolded is what I'm focusing on, to tell you the truth, total garbage.

What you described is so rare (except the drugs thing).

Fair enough. I'm not going to get into an argument with you. I guess you have your reasons for saying that but so do I.

I trust implicitly the good friends who work in 2 separate ED's who both tell me the same stories over and over. And believe it or not, its not some footy based rumor about someone who works in a coffee shop whos aunty is the second cousin of the lift operator of the mailman's apartment who lives across the road from James Aish's sisters school teacher.

 

[BRAB]

Fair enough. I'm not going to get into an argument with you. I guess you have your reasons for saying that but so do I.

I trust implicitly the good friends who work in 2 separate ED's who both tell me the same stories over and over. And believe it or not, its not some footy based rumor about someone who works in a coffee shop whos aunty is the second cousin of the lift operator of the mailman's apartment who lives across the road from James Aish's sisters school teacher.

Your ED doesn't tell you about the 99 patients that aren't idiots for every 1 that is.

 

[notliondown]

Your ED doesn't tell you about the 99 patients that aren't idiots for every 1 that is.

I'm pretty certain I didn't quote numbers, or insinuate that the majority of ED time was tied up this way. Nor did I say the people who were doing this were idiots. In fact from what I hear, some of these people are either homeless, suffer some sort of metal issue/disability or are aged. But there is a large portion who simply don't need to use ED that way. Making up some meaningless stat and passing those people off as idiots completely misses the point that you are at pains to try and make over and over.

You asked about inefficiencies of the system - I gave you an example of one area that gets "distracted" and is by definition, at times inefficient. Simple. Stop trying to make more of it than was ever intended.

Apologies for carrying this on... it'll be the last post on it from me.

 

[JasRulz63]

I've spent some time in ED during my studies and I can't say I've experienced people using the ED for panadol and such. Can't see it being worth it due to the waiting times in ED. Then again, I've only spent the day there, not nights where I assume it's more common. Drug seeking behaviour (for opioids as opposed to Panadol) I've seen a fair few times.

I've heard from some paramedics about instances where people use ambulances as 'taxis', but it's not common at all.

 

[BRAB]

I'm pretty certain I didn't quote numbers, or insinuate that the majority of ED time was tied up this way. Nor did I say the people who were doing this were idiots. In fact from what I hear, some of these people are either homeless, suffer some sort of metal issue/disability or are aged. But there is a large portion who simply don't need to use ED that way. Making up some meaningless stat and passing those people off as idiots completely misses the point that you are at pains to try and make over and over.

You asked about inefficiencies of the system - I gave you an example of one area that gets "distracted" and is by definition, at times inefficient. Simple. Stop trying to make more of it than was ever intended.

Apologies for carrying this on... it'll be the last post on it from me.

No, there ISNT a "large portion" and therefore there isn't an efficiency, that's the point.

 

[POBT]

Emergency Department avoidance is a priority of the health system. Getting people the right care for their condition means better understanding the pathways available and, more importantly, funding the providers of care. The sick homeless guy can't just be left on the side of the road. But perhaps an ED is not the best place to provide him with care.

A few of the HHSs are trialling nurse navigator models. Instead of the ED becoming the first and only point of contact with the health system for many people, the idea is to create a model which helps clinicians find the right pathway for their patients. HHSs become the coordinator of health services, working with a range of providers to ensure the patient gets the most appropriate level of care, as opposed to always going to an ED.

A big problem though is the inflexibility of our Medicare model. For instance, as I understand it, telemedicine is not covered by Medicare. That means a health service provider either has to fund telemedicine themselves or make the patient pay. Using technology could reduce health system costs and yet an inflexible funding model creates a barrier for adoption.

What I will say though is, regardless of the problems and challenges faced by our health system, I would never propose a move away from universal health care. To me, it is a fundamental component of living in a modern, compassionate and egalitarian society.

 

[notliondown]

To walk in off the street looking for care, ED will always be first choice as the system stands. Its quicker, its more accessible - and ultimately abused for that reason. One of the women who tell me these stories works in a large regional town with quite a low socioeconomic base and I think thats one of the reasons she tells these stories more often. Theres been quite a few campaigns recently trying to get people to use they system correctly... as to the effectiveness who knows. Some will always choose a free service over one they have to pay for whether they are able to or not.

I think you are right POBT, medicare doesn't really provide too much incentive to change the way we use the system right now. It's become outdated and reactive, instead of encouraging efficiencies it actually slows the adaptation of them by being so slow to subsidize smarter ways to do things.

Right now, from out here, if we need a specialist that's unavailable locally, we can get travel subsidy, accommodation subsidy - and in some cases 100% - as well as the usual medicare ones. At times theres simply not many options other than to do just that, but in a certain percentage of cases, particularly with mental health issues, telemedicine is a massive massive cost saving to the system.

 

[whatboutbob]

To walk in off the street looking for care, ED will always be first choice as the system stands. Its quicker, its more accessible - and ultimately abused for that reason. One of the women who tell me these stories works in a large regional town with quite a low socioeconomic base and I think thats one of the reasons she tells these stories more often. Theres been quite a few campaigns recently trying to get people to use they system correctly... as to the effectiveness who knows. Some will always choose a free service over one they have to pay for whether they are able to or not.

I think you are right POBT, medicare doesn't really provide too much incentive to change the way we use the system right now. It's become outdated and reactive, instead of encouraging efficiencies it actually slows the adaptation of them by being so slow to subsidize smarter ways to do things.

Right now, from out here, if we need a specialist that's unavailable locally, we can get travel subsidy, accommodation subsidy - and in some cases 100% - as well as the usual medicare ones. At times theres simply not many options other than to do just that, but in a certain percentage of cases, particularly with mental health issues, telemedicine is a massive massive cost saving to the system.

Can't help but buck at generalisations and exaggerations like that. I get the impression you think this is a bigger problem than it is (yes, I know plenty of doctors too...hundreds in fact, by virtue of being married to one).

I'm not saying abuse by a minority isn't an issue worth looking at. Hey, they are! I'm glad they're trying to educate folks. But gee there are some far bigger issues with the health system. Off the top of my head woeful IT and HR/people management waste far more money than systemic abuse by patients.

 

[Requiem]

To walk in off the street looking for care, ED will always be first choice as the system stands. Its quicker, its more accessible - and ultimately abused for that reason. One of the women who tell me these stories works in a large regional town with quite a low socioeconomic base and I think thats one of the reasons she tells these stories more often. Theres been quite a few campaigns recently trying to get people to use they system correctly... as to the effectiveness who knows. Some will always choose a free service over one they have to pay for whether they are able to or not.

I think you are right POBT, medicare doesn't really provide too much incentive to change the way we use the system right now. It's become outdated and reactive, instead of encouraging efficiencies it actually slows the adaptation of them by being so slow to subsidize smarter ways to do things.

Right now, from out here, if we need a specialist that's unavailable locally, we can get travel subsidy, accommodation subsidy - and in some cases 100% - as well as the usual medicare ones. At times theres simply not many options other than to do just that, but in a certain percentage of cases, particularly with mental health issues, telemedicine is a massive massive cost saving to the system.

I'd love to see some statistics on that 'issue', sounds too anecdotal for mine.

 

[whatboutbob]

I'd love to see some statistics on that 'issue', sounds too anecdotal for mine.

I read am interesting article about it in one of wifey's mags a while ago, looking at stats from, errrr, 2013 I think. I'll see if I can dig it up.

Off the top of my head ambulances in qld were used for non-urgent patients about 1 in 80 to 100 times and non-urgent patients accounted for roughly 5% of ED visits.

I've got a vague recollection about the data having a few question marks though.

Edit: I do remember being a bit surprised by the ACT having the highest percentage of non-urgent Ed patients.

 

[Caiphus]

Yeah, the misuse of ED is more propaganda for a user pays system than having a massive effect on budget blow-outs in real terms. The majority of people aren't that stupid or arrogant to tie up emergency medicine, but like most things anecdotal evidence can make the impact seem a lot more significant.

Even the idea of emergency wards being tied up by alcohol fuelled violence and ice patients is a large amount of truth massaging. Emergency and acute intakes are slowed by mental health issues though a fair bit because mental health services are so under-funded and inadequate that the assessment end on that front is the bottleneck.

 

[Hollow Knight]

Every welfare system is susceptible to fraud or misuse. It's inevitable.

Policies can always be improved but as long as the public benefit exceeds the cost, it's worthwhile. There is a lot of things wrong with Australian public policy at the moment but our public health system is remarkable.

 

[Caiphus]

Every welfare system is susceptible to fraud or misuse. It's inevitable.

Policies can always be improved but as long as the public benefit exceeds the cost, it's worthwhile. There is a lot of things wrong with Australian public policy at the moment but our public health system is remarkable.

Allied services on the other hand...

 

[notliondown]

Can't help but buck at generalisations and exaggerations like that. I get the impression you think this is a bigger problem than it is (yes, I know plenty of doctors too...hundreds in fact, by virtue of being married to one).

I'm not saying abuse by a minority isn't an issue worth looking at. Hey, they are! I'm glad they're trying to educate folks. But gee there are some far bigger issues with the health system. Off the top of my head woeful IT and HR/people management waste far more money than systemic abuse by patients.

Yes you are right... always was a bad choice of words. My apologies.

Again, I've never stated this was a massive issue. I didn't give it a size or ratio or make some statement that it was the downfall of the system. I simply said it occurs, and based on what I'm told, in some places more than others. Did I count numbers? No. Did I quote numbers? No. It was a comment on how the system can be made inefficient at times by a misuse that really shouldn't occur - in one particular way, in one particular example.

The accusation was that it didnt and I was making it up - that it was total garbage. The posts after that were in the context of that statement which I will defend ad-nauseam if necessary. The whole discussion is about context, which is lost when people want to pick out a post and ignore everything thats gone before it.

I don't deny for a second there's bigger issues. I didn't try ranking them or comparing them. I mentioned the "paperwork trail" which by default almost certainly encompasses ridiculous waste in IT and failed systems. I also mentioned boards and as a result the lessening of duplication and better decision making. I also mentioned earlier about how incredible the system is - its not until you have someone so completely reliant on it that you wonder just how in hell it all comes together in the first place.