Turnbull Government fails to think through aged care funding cuts

Another example of the monumental cock-up that that is the Australian Federal Government under Malcolm Turnbull & Co.

Australian Financial Review, 6 September 2016:

The Turnbull government has agreed to review $1.2 billion in aged care cuts after the sector presented modelling showing the effect would be much greater than anticipated. 

As ASX-listed providers blamed the funding squeeze for a 30 per cent drop in the value of their shares, Aged & Community Services Australia president Paul Sadler said modelling revealed the cuts would reduce support per resident per year by 11 per cent, or between $6655 and $18,000. 

He told The Australian Financial Review that the government had indicated it was willing to talk about alternative ways for find the $1.2 billion in savings to what is known as the "aged care funding instrument" announced in the May federal budget. Labor had already given a similar commitment. "The government has started the process of talking to the sector about alternative approaches," Mr Sadler said.

Aged & Community Services Australia is among a number of groups and representatives that have told the government there are better ways to achieve the savings. 

The government concession comes as the trio of listed companies operating in the aged care space – Estia Health, Regis Healthcare and Japara Healthcare – experienced a sharemarket slump that they said was driven by restrictions on what they can charge residents.

The federal Department of Health clarified last Friday that providers could not charge building refurbishment or capital replacement fees on top of existing accommodation charges. 

"It's like you or I paying rent and then being charged extra to fund the cost of maintaining the building in the future," said Grant Corderoy of Stewart Brown, an accountancy firm that conducts a quarterly survey of aged care financial performance……

Aged care funding is complex.

Costs are split into two parts: healthcare and accommodation.

In the first category, funding is largely provided per resident by the federal government based the level of support required according to health needs.

Separately, accommodation is paid for via a refundable loan (paid by the resident), an equivalent daily payment (which is either covered by the government or the resident, depending on capacity to pay) or a combination of both.

There has been bipartisan support in Canberra to deregulate the accommodation part of the equation.

While the amount that can be charged for accommodation has a regulator to monitor pricing levels, residents can agree to pay extra for higher standards of food or services; a glass of wine in the evening or massage therapy, for example.

Some providers have added levies of up to $18 a day for building maintenance and building replacement.

But last Friday the department said these charges should be included into the base accommodation pricing – they could not be charged as "added extras".

The end result is a potential loss of revenue per resident of $4000 to $5000 a year depending on the extent of the additional charge……

Literally millions of Australians in the firing line as Treasurer Scott Morrison continues his assault on the poor

On current settings, more Australians today are likely to go through their entire lives without ever paying tax than for generations. More Australians are also likely today to be net beneficiaries of the Government than contributors - never paying more tax than they receive in government payments.

There is a new divide – the taxed and the taxed nots. [Australian Treasurer & Liberal MP for Cook Scott Morrison, Bloomberg address, "Australia must take action to strengthen our economic resilience", 24 August 2016]

John Passant* writing in Independent Australia on 29 August 2016 is not impressed by Scott Morrison:

THE one sided class war continues. Only the words have changed.

Under Abbott and Hockey it was "lifters and leaners" and "ending the age of entitlement".

The "logic" behind this rhetoric gave us the horror Budget of 2014 and its proposed $80 billion in cuts over time to public health and public education.

Public opposition to that Budget was widespread, and angry. The Abbott Government never recovered and the 18 months of negative polls and the prospect of a Liberal wipe-out at the election, saw Malcolm Turnbull take over and win a bare one seat House of Representatives majority and an unpredictable Senate in the July 2 election.

Treasurer Scott Morrison has found some new weasel words to try to disguise the class war he is leading against the poor, pensioners, the sick, the unemployed and low paid workers.

After years of denying it Morrison has admitted we have a revenue problem, although he called it an "earnings" problem. According to Morrison, the great divide in Australian society is between the taxed and the taxed-nots.

In ScoMo world it is "the taxed" who have been bearing the burden of Budget repair while "the taxed-nots" have been bludging off us. Time for the taxed-nots to pull up their socks and start contributing to fixing the Budget problem.

Just who do Morrison and Turnbull have in mind as the taxed-nots? Could it be the 676 big businesses (36% of the group) which, according to the Commissioner of Taxation’s corporate tax transparency report, paid no income tax in 2013-14? Not on your life.

Could it be the likes of Don Argus – former Bank of America chairman – and his wife with their tax free pension of $1.2 million a year? Not on your life.

Could it be the 56 millionaires who pay no income tax? Not on your life.

Morrison’s prescription for the earnings problem is not to tax big business and the rich but to cut welfare payments to those who most need them — the sort of people he and others claim pay no tax.

As Duncan Storrar, in replying to one accusation that he pays little or no tax, said on ABC's Q&A:

“I pay tax every time I go to the supermarket. Every time I hop in my car.”

In fact, as I have written previously for IA:

Analysis from NATSEM, contained in the ACOSS report on inequality, shows that Australia’s tax take (including GST as well as income tax) across various income quintiles fluctuates around 25%, with those on lower incomes as a generalisation a bit below and those with higher incomes a bit above that figure. However, it gets worse when we compare the two ends of the income spectrum. The bottom 5% pay 34.2% of their income in taxes while the top 5% pay 30.1% in tax.

In other words, Australia does not have a progressive tax system.

Morrison also argued that there were millions on ‘welfare’ who paid no net income tax. By this he means that the government payments they receive are greater than the tax they pay.

Let’s be clear about this. The sort of people Morrison has in mind – and in his sights – are pensioners, the unemployed, students, the disabled, the homeless, those women fleeing domestic violence, the low paid and the list goes on.

Among these groups, the main people who pay little tax and receive much more in payments and other benefits from government are pensioners — all 2.4 million of them….

Read the full article here.

* John Passant is a former Assistant Commissioner of Taxation in charge of international tax reform in the ATO.

New Matilda, 30 August 2016:

“The new divide – the taxed and the taxed nots”

Here was an opportunity to state categorically that we need to increase our taxes, and to make those who are well-off pay their share. Instead we have been presented with a rambling discourse, dominated by his claim that there is a large proportion of Australians who “go through their entire lives without ever paying tax”.

That is plain wrong.

This year the Commonwealth is budgeted to collect $59 billion in GST, and $25 billion in excise and customs duty on tobacco, fuels and certain imports. That’s around $9,000 a household, in taxes that are practically impossible to avoid. Not even a Carmelite nun can avoid the GST.

And that’s before we consider state taxes such as drivers’ licences and car registration fees, and state and local government property taxes paid directly by homeowners or by tenants through their landlords.

Most of these taxes are regressive. The lower one’s income, the higher is the proportion of that income devoted to consumption and therefore to paying the GST, and the registration fees for a Corolla and a Porsche are pretty much the same.

That’s not to mention road tolls, private health insurance, fees at government schools and higher co-payments in health, all of which are high-cost privatised means of paying what we could be paying more fairly and efficiently through our taxes.

Morrison reluctantly admits that Australia has a public revenue problem, but he fails to acknowledge the yawning gap between what we presently collect in taxes and what we should be collecting if we are to fund adequately the public goods and a social security system appropriate for a high income country.

Our tax collections, as a percentage of GDP, are close to the lowest of all OECD countries – among prosperous developed countries only the USA collects less tax, and contrary to partisan spin, our taxes are falling.

Over the early years of this century Commonwealth taxes were around 24 per cent of GDP, before plummeting to 20 percent during the GFC and recovering to only 22 per cent now.

Read the rest of the article here.

NOTE

The Australian Goods & Services Tax (GST) taxes the final consumer of a good or service. Most unprocessed and raw foods as well as most education, childcare and medical services are GST exempt. The current GST rate is 10 per cent of the retail cost of goods and services and this tax is paid by est. 23.96 million people living in an est.10 million households. This tax is not included in government calculations of how much net tax is paid by any individual after government pensions/benefits/tax concessions received are deducted. Low income individuals/households pay proportionally more GST that middle and high income individuals/households.

[The Conversation, 24 July 2015]

TO WHOM IT MAY CONCERN: Uniting Care Australia calls for halt to funding cuts targeting fail older people

United Care of Australia calls on the government of the day (whomever that may be) to halt funding cuts.....

Australian Federal Election 2016: Abbott shafted the frail aged in New South Wales, Turnbull ignores their predicament and now Baird has turned his back

The profits of aged care homes surged 40 per cent in the past year as operators cut hours of nursing care while claiming higher payments from the federal government for servicing more of the most frail patients. The earnings boom in the sector comes after the government introduced widespread reforms of aged care in 2014, including deregulating fees and lifting restrictions on the accommodation bond that nursing homes can levy on residents. [The Sydney Morning Herald, 1 January 2016]

In 2014 then Prime Minister Tony Abbott amended the C’wealth Aged Care Act 1997 with the Aged Care (Living Longer Living Better) Act 2013.

The amendments impacted on the requirement under s104 of the NSW Public Health Act 2010 to have a registered nurse on duty at all times in a nursing home.  

The Baird Government initially grandfathered its Public Health Act until December 2015 and then awaited a report by the NSW Legislative Council General Purpose Standing Committee No. 3’s parliamentary inquiry established on 25 June 2015.

On 29 October 2015 the Committee’s Final Report was tabled with the following recommendation:

On Friday 29 April 2016 at 3.15pm the NSW Baird Coalition Government responded to the Final Report’s 17 recommendations by washing its hands of any responsibility for staffing levels NSW nursing homes:

So three days before the 2016-17 federal budget details are revealed, possibly less than 32 days until the federal government enters caretaker mode ahead of a 2 July 2016 double dissolution federal election, and at the end of a working week, this Liberal-Nationals state government announces that it is very willing to place the lives of every frail aged resident in New South Wales nursing homes at significant risk.

Perhaps he and his government are hoping that the media will quickly lose interest and, that older voters and their families will forget that they will now be playing what could possibly be a cruel game of Russian roulette if they decide to spend their remaining years in aged care.

Federal Election 2016: don't have a heart attack on Fridays

Live in a small coastal village or larger town on the NSW Far North Coast or on a Northern Rivers farm 100 km inland from the sea?

Then you have been living this situation for years.

The Northern Star, online editorial, 30 April 2016:

We live in two of the most marginal seats in Australia in the upcoming federal election and that puts us in the box seat as voters.

Our vote is crucial, what ever way you look at it.

If the Coalition wants to hang on to power it wouldn't want to lose Page, while Richmond is held by Labor's Justine Elliot by a margin of just 1%.

The past two state elections in Queensland and NSW have shown voters are swinging wildly and any form of comfortable political loyalty has flown out the window.

To be completely mercenary about it, neither major party can afford to take the people of the Northern Rivers for granted.

We live in a wonderful part of the world, that's why we are all here. But it's time for voters to rise up and demand the same sort of lifestyle someone living in the city can expect.

That's what our current Fair Go campaign is all about - closing the gap between city and country.

Health figures we've highlighted today paint a stark contrast…..

It suggests to me that our fair share of programs and support services in suicide and cancer are aimed at the wrong part of the country.

And we should demand to know from every candidate standing in Page and Richmond, what they are going to do about it?

The Daily Examiner, online, 30 April 2016, p. 1:

If you're going to collapse from a heart attack in the Clarence Valley, don't do it on a Friday says local doctor Allan Tyson.

Dr Tyson, who is a specialist anaesthetist and emergency doctor at Grafton Base Hospital, said having a heart attack on Friday was not a wise move because the cardiac unit at Coffs Harbour was only available three days a week and Friday was not one of those days.

"The standard of treatment you would get here is a standard lower than you would get if you lived in the metropolitan area," Dr Tyson said.

"Here they would give you blood thinners and hope that the problem didn't reappear

"If it was a real emergency you could be flown to John Flynn (on the Gold Coast) for treatment."

He said in contrast a patient in a metropolitan scenario would have access to the latest cardio services almost instantly…..

The Daily Examiner, 30 April 2016, p. 4:

Clarence Valley residents are more likely to die of avoidable diseases caused by smoking, drinking and obesity than Aussies living in capital city suburbs.

A special ARM Newsdesk analysis of public health data shows the long-term outlook for our region's residents is dire.

The Daily Examiner today reveals a set of shocking statistics as we ramp up our Fair Go for Clarence Valley campaign in the lead-up to the mooted July 2 double dissolution election.

We are calling for iron-clad federal guarantees on a range of issues including health, education and employment so we can have the same advantages and outcomes as metropolitan Australia.

An in-depth analysis of data from the Social Health Atlas of Australia reveals the following alarming health trends for our region.

At least 22.8% of Clarence Valley residents smoke compared to 14.5% in the region's closest capital city, Brisbane.

About 5.4% of our residents drink alcohol to excess. This figure is higher than Brisbane on 4.9%.

Almost one third of the Clarence Valley population is obese. At 31.9%, our obesity rate is higher than Brisbane's 25.2%.

Our avoidable cancer death rate of 121.5 per 100,000 residents from 2009 to 2012 was significantly higher than Brisbane's 93.6.

Deaths from avoidable heart disease in the same period hit 26.9 per 100,000 people in Clarence Valley. This was higher than Brisbane's rate of 25 per 100,000 residents.

The recent Medical Research and Rural Health -- Garvan Report 2015 confirms that death rates from chronic and avoidable diseases increase the further you get from capital cities.

The Garvan Research Foundation found regional areas also had steeper rates of high blood pressure, diabetes and mental health problems.

The report reveals many reasons for the health disparities, but most of them revolve around a set of social factors that include smaller household incomes, higher risk jobs such as mining and farming, a lack of similar specialist medical services compared to metropolitan Australia and the higher cost of transporting healthy foods such as fresh fruit and vegies to our region.

"The foundation of all good policy is a solid information base and a good understanding of the realities facing any sector of the population," Garvan chief executive Andrew Giles said.

Australian Medical Association vice-president Dr Stephen Parnis agreed, saying it would take long-term commitments from successive governments to reverse the Clarence Valley's negative health trends.

Dr Parnis said the first step towards bridging the gaps was ensuring our region had the same health services as those available to capital city residents…..

The Northern Star, 30 April 2016, pp.1 & 6:

The suicide rate per 100,000 in Sydney is 5.3%. In the Northern Rivers it's 12.5% Avoidable cancer deaths per 100,000 people in the Northern Rivers is 103.7. In Sydney it's 95.1…..

"I need to keep across the readings. But as a pensioner I won't be able to afford the 29 tests per year."

Pathology companies are threatening to introduce a $30 co-payment for all medical tests, including pap smears, MRIs and blood tests, if the government goes ahead with the cut.

Mr McPherson's cluster headaches -- much more significant than migraines -- usually take 10 to 12 years to diagnose.

"The lithium reduces the pressure in the nerves. I will need lithium monitoring for the rest of my life," he said.

"I'm about to go on my second program of lithium which is only used in extreme cases of this condition.

"Everything I do has to be inside because light is a trigger for this condition."

"When I saw the Federal Government had made a decision to stop bulk billing of blood tests and pap tests and MRIs, I realised the situation was going to be quite awkward on a pension," he said.

This week doctors at 5500 private collection centres began approaching their patients to sign a petition asking the Senate to block the cuts.

However, according to a new report from the Grattan Institute, taxpayers could save over $240 million a year if the government made pathology companies tender to provide testing services. According to the report, pathology companies now benefit from cheaper, automated testing.

Far from calling for an exemption for his specific case, Mr McPherson has instead called the cuts a war on women.

"Women will die because they will not get regular pap smears which can detect and prevent cancer. It's false economy," he said.

"At cabinet level, did they have a document, which explored the impact of this policy in term of rates of mortality for women?

"And did they say we can accept that?

"Someone has made a decision here, without thinking of the broader impact of the community."

News Mail, 30 April 2016:

Getting good doctors to commit to the bush long-term is a huge struggle so two of the country's key health lobby groups have prescribed a simple remedy - more money.

The Rural Doctors Association of Australia and the Australia Medical Association say there is room in the multi-million dollar Commonwealth-funded Service Incentive Payment program to apply higher remoteness loadings for GPs happy to relocate from the city.

In releasing the RDAA and AMA's Rural Rescue Package, Dr Ewen McPhee said extra financial support aimed at "revitalising and sustaining" rural medical services could be the key to closing health gaps.

The RDAA president said financial incentives based on the remoteness of the area in which GPs worked was the way to go.

"Over the past two decades, many rural and remote communities have found it increasingly difficult to attract and retain doctors with the right mix of skills to meet their health and medical needs, including GPs with advanced skills training who can provide acute services in the hospital setting," Dr McPhee said.

"The Rural Rescue Package would make a huge difference."

The Daily Examiner, 30 April 2016, p. 5:

Maclean Hospital has a constant wish-list of equipment that government cannot fund, so a dedicated group of women and men take it on themselves to do something about it.

The Maclean Hospital Auxiliary have been raising money for the past 70 years and in the past year have raised about $75,000 for the hospital.

Add this to another $107,000 of equipment on order, and that's a lot of cakes and biscuits being sold at stalls.

"They give us a wish list, the articles they need, and then we go down through the list and supply them with whatever monies we have at the time," president Sandra Bradbury said.

"We do various fundraisers, we have four stalls a year, street stalls and we bake cakes."

Without the help of donations, Mrs Bradbury said the hospital would not be nearly as well off.

"It used to be a full running hospital and now it's not... years ago it used to have a children's ward and a birthing place," she said.

The Daily Examiner, online, 29 April 2016:

This is a tale of two babies.

They were born 600km apart, but statistics suggest their prospects are worlds apart.

Data shows Clarence Valley newborn Charlotte Billett, pictured above with parents Stacey and Jeremy, is at risk of dying 4.9 years earlier than Sophia Milosevic, pictured right with her mum Kate.

For both children, their distance from capital cities makes all the difference.

Sophia's home is in the Federal seat of Bennelong in the north of Sydney, a seat long held by former prime minister John Howard.

Charlotte was born in Grafton, 310km from Brisbane and 890km from Canberra.

A special Daily Examiner investigation reveals how regional Australia has been let down, with health, education and infrastructure funding failing to help those who need it most.

In Grafton, the life expectancy for a baby born in 2014 is 80.4 compared to 85.3 where three-month-old Sophia lives in the Sydney suburb of Ryde.

Australian Bureau of Statistics figures reveal the median age of death for locals is 80 compared to 84 in the Ryde council area…..

Public health policy expert Dr Rob Moodie said Grafton's life expectancy rates and median age of death would not improve until the Clarence Valley matched its metropolitan cousins on income, education, employment and access to more top-quality health services…..

The Norther Star, 28 April 2016, p.6:

Over 420,000 Australians have banded together to back up pathology centres in their fight against cuts to bulk billing incentive payments.

Local collection centres advertised their Don't Kill Bulk Bill petition for patients to sign and health centres to get on board.

Natarsha Wotherspoon of Lismore chemist, Blooms, wanted to help.

"It's hard to come up with money for all your health needs ... How many people can't afford to eat, let alone pay for a blood test?" She said.

"If you're very ill and you're getting blood tests two or three times a week, the last thing you need to be thinking about is how you are going to pay for all these tests."

Ms Wotherspoon and the other chemist staff collectively gathered over 2000 signatures.

The Turnbull Government announced on December 17 it would scrap payments to pathologists and diagnostic imaging services when they bulk billed patients, saving $650 million over four years.

Health Minister Sussan Ley said the sector could absorb the losses, but pathologists disagreed.

President of Pathology Australia Nick Musgrave said pathologists would have to charge patients a co-payment…..

The Northern Star, 23 April 2016, p.8:

They were born 730km apart, but statistics suggest their prospects are worlds apart.

Data shows Frankie Lindsay is at risk of dying four years earlier than Sophia Milosevic, pictured right with her mum Kate.

For both children their distance from capital cities makes all the difference.

Sophia's home is in the Federal seat of Bennelong in the north of Sydney, a seat long held by former prime minister John Howard.

Frankie was born in Casino, 195km from Brisbane and 1000km from Canberra.

A special Northern Star investigation reveals how regional Australia has been let down, with health, education and infrastructure funding failing to help those who need it most.

In Lismore, the life expectancy for a baby born in 2014 is 81.2 years compar- ed with 85.3 where three- month-old Sophia lives in the Sydney suburb of Ryde…..

Meanwhile, Ms Milosevic said there was no better place to raise a child in Australia than Ryde.

"It is a Liberal seat so it seems to do very well for itself," she said.

"There are constantly things happening, new playgrounds and projects with new funding.

"It's brought a different demographic of people and the area has become quite affluent."…..

The Northern Star, editorial, 23 April 2016, p.9:

…..Prime Minister Malcolm Turnbull will take the country to the polls within months.

Getting a Fair Go for our region will be our priority through the election campaign.

Mr Turnbull and Bill Shorten have questions to answer. Their parties must prove we are a priority.

Our sister papers across Queensland and northern New South Wales - and those of NewsCorp - will fight for the same thing.

Together, we represent the more than 6 million Australians who don't live in the big cities. Combined we reach 3.3 million readers a month.

Politicians beware: That's a lot of voters.

One in three Australians live in the regions - and they deserve the same access to health care, education, and employment prospects as those in our capital cities.

They're not getting it now, and that has to end.

Living in the bush, or at the beach, should not be a life sentence.

Little Frankie deserves better.

In his 2017-17 Budget speech last night Treasurer Scott Morrision announced an estimated additional $2.9 billion over three years for public hospital services.

With this sum having to be cut seven ways between the states and territories, I think one may safely say that Far North Coast health services will continue to lag behind those in the metropolitan areas across Australia and our life expectancy and health outcomes will continue to be lower under this federal government.