Access block
by John Pratt
The inability to admit emergency patients to a ward bed in a timely fashion (access block) is a blight on our hospitals and our community. Access block is the most serious issue confronting emergency departments (EDs), as the safety and quality of emergency care are compromised, as is access to emergency care.1 There is a 20%–30% excess mortality rate every year attributable to access block and ED overcrowding.2 This equates to at least 80 deaths per million population, a figure that is similar to the road toll.
According to the Medical Journal of Australia over 2,000 Australians die every year while waiting to be admitted to hospital emergency departments. No wonder doctors are frustrated. What would happen if we were faced with a large scale disaster?
Would Australia be able to cope with a terrorist attack, which may see our emergency departments looking for thousands of extra beds? Even an outbreak of bird flu or something similar would see the Australian hospital system completely fail.
We spend untold millions on the threat of terrorism and fighting foreign wars while at the same time we underfund our hospitals. This results in a death toll in our hospitals equivalent to the death toll of the 9/11 attack and we do nothing.
Why do we let fear of a terrorist attack outweigh the real danger of dying in an underfunded hospital system?
If we were to fund aged care facilities properly many of our hospital beds would become available.
Gail Milner from the WA Department of Health told the Senate’s Finance Committee that each day there are between 420 and 440 older clients waiting for residential care throughout the state.
A quarter of these clients are waiting in public hospital beds.
Ms Milner said that close to 1,500 approved aged care beds in WA are not operational and only 56 per cent of the available beds were likely to be taken up in the current Aged Care Approvals Round (ACAR).
One of the reasons our aged care system is failing is the current funding is inadequate.
The aged care sector has warned the Federal Government there will be a shortage of nursing home places within a few years, unless it overhauls the funding rules.
The head of the Aged Care Association of Australian, Rod Young, says there are indications that many providers across the country have declined the offer of nursing home beds because they cannot afford to fund them.
He says they do not have the money to build new nursing homes.
The AMA has revealed that understaffing and bed shortages are posing a deadly danger to patients. The number of hospital beds per 100,000 people over 65 has dropped by 67 percent in the last twenty years.
The 2008 Public Hospital Report Card by the Australian Medical Association (AMA), released last November, revealed that understaffing and bed shortages nationally posed a serious and deadly danger to patients. The number of public hospital beds per 100,000 people over 65 had dropped by 67 percent over 20 years.
The country's major teaching hospitals were "commonly operating on a bed occupancy rate of 95 percent [with] some jurisdictions set[ting] a bed target rate of over 90 percent" and "rates of over 100 percent are not uncommon". According to studies by the Australian College of Emergency Medicine, an occupancy rate of more than 85 percent "risks systematic breakdowns, extended periods of ‘code red' and puts patients at risk of mortality and disability".
Why do we let our politicians get away with this? One day it might be you in the emergency waiting room, and the one who dies may be your spouse or child.
I see reality is beginning to dawn
John Pratt: "Paul, what if we really embraced the ideas of globalisation and there were no tax havens? If international tax laws were brought in so that the rich could not hide their money in Swiss bank accounts or avoid tax by basing themselves in Cayman Islands?"
Nobody should and of course won't drop their standards because others won't or can't pick theirs up. There's nothing wrong with other nations poaching Australia's best and brightest (Australia does the same), and there's nothing wrong with legitimately poaching future funds. One should take the best deal on offer.
If Australia is too weak to hold on to what it has, it doesn't deserve it.
And the recent elected governments got elected promising tax rises? Not for their needed voters they didn't. And freebies aren't of course greed. And neither is the lust for power. Or is it?
The Swiss, by the way, enjoy a much higher standard of living than most. They're certainly not looking for change, and they'll never be forced to change. Too many friends in high places, probably more than a few a part of socialist governments.
We should look at tax for what it is. Theft. Any other entity claiming money that wasn't earned would face the wrath of the law. It's not possible for one to steal one's own money. Therefore there isn't anything morally wrong with evading tax. Lawfully (a human concept) there may well be, only though, if one is found guilty.
People should have right to direct "their" money to where they see fit. Tax should be treated for what it is - charity.
The top ten per cent of earners carry the burden of all western nations. Around fifty per cent of people aren't net taxpayers. We get out of life what we put into life. If your system is falling apart, perhaps it's time to ask a few more to pony up. A tax on consumption and less taxes on production would be the most sensible option. A flat income tax similar to the Czech Republic would also be a good option.
Until such a day, expect funds to continue to dry up. Yes, be poached away. Welcome to the world of competition.
To each according to their needs
Paul: "If Australia is too weak to hold on to what it has, it doesn't deserve it."
So your idea is the weak do not deserve. Only the strong deserve.
So might is always right?
I would like to think we can rise above that. I would like to have a society where to each according to their needs is more the rule.
It seems to me if we go your way we are destined to eternal wars and eventual extinction.
The dawning of reality
John Pratt: "Paul, I don't know if you a religious person or not but even the head of the Anglican church is calling for change."
I'm not calling for a change, I'm telling you where society (in all western nations) is headed. There's been millions of words written on the subject over the last thirty years. Probably billions. The state was never able to supply a stay at the Waldorf on a YMCA budget. To believe that this will suddenly become possible is a form of society agreed self delusion.
The post WWII generation is the first generation of the state moving toward retirement. All previous generations clearly understood they would have "lifestyle" responsibility placed upon the individual when this occurred. A brutal truth in many instances, a truth all the same. So yes, perhaps many of the post WWII generation were conned. I don't really know.
I do know that future generations won't be concerning their entire lives with getting those people out of trouble, and doing all possible to grant them the life they may believe they should be accustomed. In the end, John Pratt, we wear our own mistakes.
If you supply only disincentives, that's exactly what you get. You would be hard pressed finding anyone (and I mean anyone) stupid enough to pay such an amount. The amount you speak of is ridiculous. People would either not bother earning such an amount or they would go elsewhere.
The Nordic nations, once the pin-ups of socialism, are now facing such reality. Savings is the forgoing of something in the present for something in the future. The reverse of this also applies. The money has been spent, and the credit card is maxed out. There's no last chance saloon.
A guy in Asia is at the moment working a seventy hour week. He's earning half what the most well educated person, spending his every idle day in a Swedish park (State funded) is earning. This situation won't remain the same forever: the Asian guy will win, and if he doesn't, his children will.
Seeminglym anyone with a calculator is tarred with the "neo-liberal" tag nowadays. Probably the neo part is used to hint of Nazism or something. I don't know and I don't care. It's always been and it'll always be about freedom versus socialism. People can use whatever tags they want.
I do know that free market philosophy isn't over. It'll back at a later date, just as strong as its always been. Any changes made today can and surely will be reversed tomorrow. That's also the cycle.
What if there was nowhere else to go?
Paul, what if we really embraced the ideas of globalisation and there were no tax havens? If international tax laws were brought in so that the rich could not hide their money in Swiss bank accounts or avoid tax by basing themselves in Cayman Islands?
Did you read the piece by Rowan Williams in my last post?
We need a change in attitude - greed is out. Most people would be happy with $100,000 tax free.
We should look on tax as a good thing. If we were paying high tax that means we are really giving to our country.
It's funny, isn't it? We think it is alright for a young soldier to give up his life for his country but never ask a rich many to give up some of his money for anything.
Neo-liberalism is over
Paul, neo-liberalism is over. It has failed to deliver. We are now looking for alternatives.
The free market will never look after the environment or the weakest in our society. It is up to the state to stand up for the planet and for the weakest amongst us.
I realise that a lot of what I write is idealism, but I feel unless we aim high we are sure to fall short.
I still believe that we can afford to look after our sick and elderly. I believe that we can abolish tax below $100,000 and tax incomes above $100,000 at 90 percent if we choose to do so. The majority would be better off, don't you think?
You say business would go offshore. Paul, unless you have missed the last thirty years or so that is just what they are doing anyway.
Paul, I don't know if you a religious person or not but even the head of the Anglican church is calling for change.
When one misreads the market one can go broke
John Pratt: "Paul, you're right - fully taxpayer funded education and health are not free."
Only nothing is free.
If you wish to treat something as an investment, you'll need to be a little analytical. Simply wanting something to be so doesn't necessarily make it so.
No doubt.
Which particular society should be the point of contention. For example, the "free" education policies of Europe throughout the sixties and seventies were America's greatest post WWII policy.
The European outlook was simple. One would receive a quality education without cost, and then emigrate to America to find fame and fortune (mostly just low tax rates). Taxes (yes, even for Europeans) of course only become a problem when one needs to pay them.
I don't know if a study has ever been conducted on the particular subject. I personally would think that the looting of future European GDP, throughout that time, would make Iraq look a cut price picnic. American policy makers would be well served reviewing that time period. Looking about I now see a number of Asian nations positively bringing back the flares (taxation rates are positively entralling and getting better). Only now America is the one having the job done upon it.
Sometimes to take less is to take more. A lesson very few ever really learn.
We live in a competitive world, and it's getting more so. It's a market place out there (it's a big wide world), and in any market, one's biggest mistake, is pricing one's self out of it. Europe did long ago, and that's why Asia will soon take its place.
Australia has throughout its time (my reading) had incredible luck bestowed upon it. It comes down to being in the right place at the right time. How well Australia now pushes that luck is down to Australia. Great opportunities, I might add, don't come around often.
And so may dream
John Pratt: "Most Americans would vote for a universal health system."
And most would vote for a free car and paid trip to Rome. The chances of getting those things are about the same as getting quality universal medical services.
To be socialist, one needs a total disconnect with the laws of mathematics. Given the universal truth of mathematics, that's no mean feat.
With respect to John, he seems to be of the belief that Australia should have the world's best medical services available to everybody. Saying (simply voting) that something should be so is seemingly enough.
John also wants a ban the mining industry (easily Australia's biggest export), payment of a wage to everybody not working, in excess of what 80% of the world's individuals earn, as well as supply for all their life needs (top drawer of course). He also wants to clamp huge tax increases on business (already leaving), and those silly enough to still be employed (probably mentally ill), and pay doctors and nurses really big dollars (nothing wrong with that) because they're better than insurance people.
John would also like to tax people earning over 100k at 90% (which must include those now big earning doctors and nurses). A rate I might add that would cause the worst Mafia don to blush (thank you masta for allowing me ten percent of MY money). Australia can (according to John) achieve all this because it's "rich". Seemingly John concedes his ideological forefathers didn't kick the place off.
A pity for the Aboriginals really; they came, they saw, and they conquered. And then they all went home. They were liquidated owing back taxes.
Best of luck in your quest
John Pratt: "A universal health system would be more efficent than one funded by private insurance."
Possibly. It would take a lot of money to make so. Something that not one country has been able to find up to date. People may want the best "free" universal healthcare in the world, they're not willing to pay for though. Putting one's neighbor on the "net payment roll" doesn't count.
Fifty per cent of western citizens aren't net taxpayers, and the number grows ever onward. For example: forty thousand people pay for New York City. The numbers are astounding, and I believe the "born as a right" western lifestyle is a ticking bomb. People may believe in universal free health. That belief, though, often comes with "universal" meaning somebody else paying. Politicians of course will pander to this, until there isn't any other option but to face the truth. A truth that may come a lot quicker than people think.
I think "basic" (as opposed to quality) unversial healthcare, eduction ... will become the optimal word soon. That's about as good as it's going to get.
Insurance companies are in the business of making money, the same as any other business. The business of being in business is offering a service. Medical insurance would involve "access" for their clients - "rich" or not.
Actually, you'll probably find the wealthiest Australians don't have medical insurance. Insurance is just that, insurance. If one already easily has the funding, one doesn't need to be insured. The wealthiest Australians (happens in many nations) would have access to premium world-wide medical care (in whatever specialist field), it's only a matter of payment. Insurance companies in Australia probably don't offer coverage for American etc services at any rate.
Aged care is heading towards a train wreck
This is a very cynical piece on a Liberal Party website:
Although I agree with the sentiments expressed, this is from a party that neglected aged care while it was in power. How could we trust them to behave any differently if they were to regain power?
We are indeed facing a crisis, and political posturing is no way to fix the problem. Thoughtlessly throwing money at the problem is no answer either.
As a society we need to work out the best way to care for our mothers and fathers. What we are doing currently is failing to meet their needs. The only way to solve the problems we are all facing is to work together and give aged care the priority that is deserves.
Health care - a major domestic concern for Americans
Most Americans would vote for a universal health system.
Universal health care is cheaper.
Nice world, pity it can't exist
John Pratt: "We need free education and free health".
I think you mean fully taxpayer funded. Nothing of course comes for nothing. Somebody, somewhere, always pays something.
The Government didn't luck on to some money under a tree. It borrowed the funds. The funds will need to be paid back with interest.
Insurance is a way many people can cover debts they wouldn't otherwise have funds available for. The point I make is that if you want the best of something, you'll need to pay the cost. That's how things work in the world. Insurance for many individuals is protection when such times arrive.
A nation can of course decide to take this step. Personally, I wouldn't advise it. The downside will be much, much, greater than any upside.
I'm sorry John, but all the willpower in the world isn't going to make the Australian health service any better. People will at one point need to make the tough decisions (if top quality is aimed for). Somebody, somewhere, unfortunately is going to miss out. That's also the unfortunate way of the world.
Universal health care and properly funded aged care are cheaper
Paul, you're right - fully taxpayer funded education and health are not free. We should look on them as investments. A better educated society should be a more productive society. A more productive society would pay more tax and we would all benefit.
A universal health system would be more efficent than one funded by private insurance. I fail to see how paying for non medical employees such as insurance brokers, accountants and customer service staff could compete with a system that pays only medical staff directly working on the ill.
I think the insurance companies are parasitic and only add unnecessary cost to the health care system. As I have said before, their only function is to ration who gets what care insuring the rich always get better access.
As for looking after the elderly, it is cheaper to look after the elderly in aged care facilities than in acute care hospitals. It would be cheaper to fund properly the aged care system properly than to have the elderly taking up acute care beds.
I have said on other threads that we have a population problem, so we need to make sure everyone is gainfully employed. Currently unemployment is rising so we have the people to fill any positions in the health care areas.
If we ever get to full employment again then we should pay health care workers to reflect the priority we should put on health care. A good doctor or nurse is worth a lot more than an accountant or an insurance broker in my book.
There isn't a "free" answer to your problem
John Pratt: "Why do we let our politicians get away with this? One day it might be you in the emergency waiting room, and the one who dies may be your spouse or child."
That every person doesn't enjoy the treatment, as if in an episode of House, is far from surprising. And it's one of those rare things that politicians cannot be blamed for. Health and education consistently outpace inflation, and that's not going to change any time soon.
Both areas have a limit to the quality available. Doctors and nurses cannot be found out of thin air. Health is a profession, and like all professions, it takes time turning out professionals. Supply is simply not keeping track with demand, and with expected mass demand, this isn't going to improve in any western nation.
As treatment improves so does life expectancy, and so does the competition for for finite quality. I note, John, you are one who is negative about even minimal birth rates. I'd be interested in knowing, who then, is to treat this aged population?
Secondly it's about money (yes, yes, I know, not that again). With fifty per cent of people (round figure in western nations), not net tax payers (this number is continuing to rise), where are the ever increasing numbers to be found? The unpalatable fact is that the numbers aren't going to be found. Basic (free) service won't slide (not in the short-term), it just won't progress. Which morphs into a silde.
The key answer lay in a strong private health industry. People willingly pay excess for any number of products. There isn't any reason why health shouldn't be the number one on the list of products. Good health is the most important thing a person has. How could any individual not expect to pay for the best service? It's that way in every other area of life.
I just can't understand people who refuse to take up medical insurance. "Most" can afford it (be it many making cuts in less necessary areas). People unfortunately choose to roll the dice. Medical insurance is the type of thing you never want to get your money back on (hopefully its not needed). I can only assume, people decide to live for the day, and accept whatever tomorrow brings.
Ps I didn't write the above as some kind of support for insurance companies. That in itself is a separate issue.
Health and education should be free
Paul, it's hard to believe that money is the problem with our health care system.
We choose to spend millions on overseas adventures like Iraq and Afghanistan, Rudd can find billions to stimulate the economy in the blink of an eye. Money can always be found if we make up our minds to do something. The hospital and aged care systems in our country are run down because we do not see them as a high priority.
Insurance is just a way of rationing the medical system. The rich can always afford insurance and will always get first place in the health system under the current system.
The poor who can barely afford to put a roof over their heads and feed the kids have to make sacrifices and insurance is often the first to go.
The reason we don't have enough trained doctors and nurses is because we don't place high enough priority on education.
We need free education and free health.
We are a rich country; we can afford it.
If we can afford to pay corporate executives millions in bonuses we can afford to pay for our hospitals and schools.
It is just a decision - we could tax all income above $100,000 at 90 per cent if we need to.
Insurance is a con. How much money has been lost in the last 2 years or so as invested insurance money has been lost on the stock market?
All insurance does is add an extra layer of cost onto our medical system.
Who do you think pays for the insurance companies? The advertising, and all the unnecessary add on expenses to our health system.
We need doctors and nurses, not insurance brokers and accountants!
Build or cull - you make the choice
It is easy to say there is too much clinging to life. My experience having worked in aged care for seven years is that most of us do not act until it is too late and we are no longer of sound mind.
Aged care facilities are filling with dementia patients, our hospitals are filling up with the overflow, and young kids are dying as a result.
We need to act now: we either build more aged care facilities or we begin culling at age 75 or so. You make the choice.
Happy birthday for yesterday Charles Darwin
The planet, John Pratt, has made a choice: let nature take its course.
Although a variable culling age has its attractions: how old are you?
Compassion?
"let nature take its course"
Hear hear, Malcolm!
As for culling after age 75!
Come on, John. If you had , say, a brother of that age in good health, would you seriously consider "culling"?
Such a bizarre and inhumane notion!
My dad will be 75 in July. He's fit as a fiddle. Not so Mum. She has psoriatic arthritis. She is only 71, very switched on mentally. However, it is becoming increasingly difficult for her to function physically. Her fingers have shrunk. She finds it hard to do the things we all take for granted. She'd be lost without my dear Dad (her loving husband) to help her.
We have no compassion
Don't talk to me about compassion, Kathy. I have worked in the aged care industry now for about seven years. I don't do it for money I do it out of compassion.
I wasn't advocating culling; it was your friend Malcolm. I was advocating for more aged care facilities. I said we should be building them now and if we fail to act, thousands will die. They are dying now according the the Australian Medical Journal. Your friend Malcolm dismisses that as just statistics. But I live the reality.
Letting nature take its course in my book means do nothing.
Doing nothing means that more and more old people will fill acute care beds and more young people will die unnecessarily due to lack of acute care beds and ambulances.
I go into aged care facilities and I have picked up scabies and gastro from the unfortunates who live in them. I am advocating for a compassionate answer to the problems we face. We must build more age care facilities.
We live in an uncompassionate society when we fail to provide for our aged and also fail to let them choose the time of the death.
We condemn many to a terrible death.
That is what "leaving it to nature" really means.
If you don't believe me go into the dementia wards and high care wards of our aged care facilities. Spend some time in the car parks of our emergency wards and see the lines of ambulances waiting for admission with young people dying because there are no beds in the hospital.
That is the reality and believe me, nature is taking its course.
Hear hear Malcolm
I always thought that Claude was probably channeling Bulgakov's wonderful creation Behemoth and I suspect that Malcolm has been missing the beast. Who wouldn't?
Agreed, too much clinging on to life. I first thought that the Buddhists might have something going on while simultaneously reading the Tibetan Book of the Dead and working in an aged care unit. The Tibetans traditionally use an astrologer to determine the time of death as they say that the body, being a disciplined entity, carries on after death has occurred. Western medicine has developed numerous ways to keep the body going on and cruelly on well after all real signs of life have disappeared. We even have a saying for it which is that "the lights are on but nobody is home".
Blissful death, to be feared by those who have not lived well enough and warmly welcomed by those who are at peace with their ambitions and conscience.
Statistics and the medical god complex
According to every reliable statistic I have ever seen, 100% of people die permanently. Why stave off the inevitable? Live with it.
Last rights
Very true, Malcolm. It is our inherent fear of death that prevents us from approaching the issue sensibly.
Looking back on events, its clear to me that both my parents acted in subtle ways to ensure that they died with dignity, while keeping to the moral codes of their generation.
To claim a right to life without acknowleding that that means an equal right to death is absurd. A right means that it is a choice - otherwise it is forced on a person without choice.