Monthly Archives: November 2018

Ouch, that’s expensive! The lowdown on the high cost of surgical specialists

Posted on 16/11/2018 by

Are surgeons fees a reasonable reflection of skills and professionalism or are they extortionate and unethical? Dan Harrison takes a patient look at operational matters.
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Why the fuss about surgeons fees this week?

The issue hit the headlines after the Royal Australasian College of Surgeons issued a strongly worded statement taking aim at some surgeons, including some of its own members, for charging “extortionate” fees, and threatening to take action against those found to be acting unethically. The college’s intervention coincided with a hearing in Canberra as part of a Senate inquiry into the broader issue of out-of-pocket health costs. The inquiry, which was initiated by Greens Senator Richard Di Natale, partly as a way of scrutinising proposals for fees to visit GPs, is due to report on Friday.

What kinds of fees are we talking about?

The Medicare benefits schedule limits how much Medicare will pay for particular procedures, but some surgeons complain the Medicare schedule has not kept pace with increases in practice costs. Surgeons are free to charge what they like, with the patient or their health insurer left to pick up the difference. Prominent neurosurgeon Charlie Teo  said while the standard fee for the removal of a brain tumour is about $2500, he believes the complexity of some cases justifies a fee of $10,000.

How widespread is the problem, and is it increasing?

Stephen Duckett, a former head of the Commonwealth health department who is now at the Grattan Institute, presented evidence to the Senate inquiry showing that between 2007 and 2013, out-of-pocket costs for operations increased by more than 25 per cent in real terms, more than any other category of service covered by Medicare. Almost a fifth of all health spending comes from consumers directly, Professor Duckett wrote, noting Australia’s reliance on such payments was higher than Canada, New Zealand and the UK.

I think my plumber is pretty expensive too – don’t market mechanisms establish prices and competition protect consumers from price gouging?

The market for surgery doesn’t work so well, because we tend not to shop around for an operation in the same way we might for other goods and services. Typically, our GP will refer us to a specialist, who will provide an indication of the likely cost of the procedure. But with no point of comparison, it’s hard for us to tell whether the surgeon’s fees are reasonable. Surgeons who compare notes with their colleagues on their fees risk falling foul of competition rules. The College of Surgeons said this week it was talking to the Australian Competition and Consumer Commission about how surgeons might be more transparent about their fees without breaching the Trade Practices Act. But the Australian Medical Association has already voiced its strong opposition to the idea of allowing patients to compare surgeons’ fees online, with AMA president Brian Owler, also a neurosurgeon, saying it wasn’t possible for surgeons to publish their fees because they varied depending upon each patient’s circumstances.

What could be done to fix it?

Dr Teo has suggested Australia adopt something like the American Medical Association’s “22 Modifier” policy, which requires surgeons charging high fees to supply evidence that the service provided was substantially greater than the work typically required for a certain procedure. The Consumers Health Forum says the Commonwealth could help patients assess whether fees are reasonable by publishing data on average fee structures, which it routinely collects but does not release. Terry Barnes, a policy consultant who worked for Tony Abbott when he was health minister in the Howard government, has suggested surgeons be forced to accept a cap on their fees in return for Medicare subsidies.

Surgeons might be expensive – but I get what I’m paying for, right?

Not according to College of Surgeons president Michael Grigg. He says in medicine, often the reverse is true. Some ethical, well-trained surgeons charge modest fees and are kept busy with referrals from colleagues who know they do good work, while other surgeons with less work charge higher fees in the hope of fooling patients into thinking they deliver a higher quality of service.

Often it’s the add-on costs – the anaesthetist, assistants, theatre fees, devices and medications – that give patients bill shock. What consumer protections exist for getting timely and accurate information about costs?

It’s really up to the patient to clarify what costs they might incur, including from anaesthetists and surgical assistants, and for hospital accommodation as a private patient, before consenting to the procedure. If the fees quoted seem excessive, speak with your referring doctor about seeking a second or third opinion.

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How the nation will commemorate WWI

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For full coverage of the WWI commemoration click here
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It is a letter that must be repeated hundreds of times within the military records of the Australian War Memorial. In neat handwriting dated April 4, 1921, a mourning mother asks the Defence Department for a memorial scroll for her son who died from his injuries in World War I.

Emma Henderson from Cowra lost her eldest son, Edward George Henderson, a blacksmith aged 21, when he signed up in the battle of Passchendaele on the Western Front. He sustained injuries to his left thigh and was brought home in April 1918 but died a year later at Randwick Hospital.

She enclosed a newspaper cutting in which she learnt that the next of kin of the 60,000 dead could apply for the scrolls commemorating those who “at the call of King and Country, left all that was dear to them, endured hardship, faced danger and finally passed out of the sight of men”.

On Monday, the centenary of the outbreak of World War I, the nephew of Edward, Rod Henderson, will lay a symbolic wreath on his uncle’s grave in Cowra as diplomats of some 18 nations gather in the town to the ring Australia’s World Peace Bell at 4pm. Representatives from Serbia, Austria, Germany, Italy, Hungary, the US and Japan will each ring one peal of the bell.

The next day the town will also mark the 70th anniversary of the Cowra breakout, in World War II, when at least 1104 Japanese prisoners of war attempted to escape from a camp.

The German consul-general in Sydney, Hans-Dieter Steinbach, said it was important to remember the past but to also strive for peace.

“My foreign minister recently said that the starting of the First World War was a kind of failure of diplomacy and that’s how I see it as well,” he said.

“It is important to remember and learn the lessons. Germany has a a couple of commemorations this year. This is 100 years of the First World War, 70 years of the [Cowra] breakout of the Second World War and 25 years of the falling of the wall in Berlin, so for us it is a very important year.

“I think it is a very solemn situation and for a diplomat it is extremely important to use all ways to maintain peace.”

The director of the NSW Office for Veterans Affairs, Darren Mitchell, said  the recent event in Ukraine demonstrated there was always the need to look for ways to work together rather than fight.

“We look back on this history regrettably, but we seek to offer international understanding and reconciliation at every opportunity,” he said. “This is a way of expressing that symbolically.”

On Monday there will be  various events across Australia, including a Last Post Ceremony, which is expected to be attended by Prime Minister Tony Abbott, at the Australian War Memorial at 4.45pm.

Premier Mike Baird and Opposition Leader John Robertson will attend a wreath laying ceremony at the Anzac Memorial at 11am.

At 4pm the University of Sydney War Memorial Carillon, which commemorates the 197 undergraduates, graduates and staff who died in the war and comprises 54 bells, will play Chopin’s Funeral March and national anthems. It will conclude with a tolling of the Australian Imperial Force bell 197 times, representing the number of names on the memorial in the cloisters.

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The present may be digital, but don’t discount the future of film just yet

Posted on 16/11/2018 by

Perfect image: Will Pulp Fiction star Uma Thurman look as good in digital? Director Quentin Tarantino believes not.More The Big Picture columnsMovie session timesFull movies coverage
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Film is dead. Quentin Tarantino read the last rites at the Cannes festival this year when he arrived for a special 20th anniversary projection of Pulp Fiction. He was asked about the rise and rise of digital, both as a means of making and screening films, and he wasn’t happy.

“As far as I’m concerned, digital projections and DCPs [are] the death of cinema as I know it…The fact that most films are now not presented in 35mm means that the war is lost. Digital projection, that’s just television in public. And apparently the whole world is OK with television in public, but what I knew as cinema is dead.”

Why should you care? I’m glad you asked.

A DCP is a digital cinema package, a hard drive with a movie loaded onto it. Most of the world’s cinemas now plug these into digital projectors, which they have been encouraged to install by the major studios over the past decade, at vast expense. Someone presses a button and the movie runs, usually without a hitch. What could be wrong with that?

When celluloid ran on reels, they deteriorated with every screening. The film would jam, having to be cut and spliced, and those seeing a film in Woop Woop three months after it came out got the rough end of the pineapple. Surely digital is better? It’s the same after 1000 projections as it is after one.

Nope, not really and not quite. Digital doesn’t deteriorate, but theatres do. That Woop Woop theatre may not be able to afford modernity. Many such theatres will close down because they can’t spend $150,000 on a new digital projector for each screen. And if they try to do good original programming, as some rural cinemas in Australia do, they are going to find it harder to get prints.

This is already happening in the US, where studios such as Fox have announced that they will soon stop supplying film prints. If the Woop Woop Regal wants to show a mint print of, say, Lawrence of Arabia, they will have to settle for a DCP, which doesn’t look as good. And the studio will decide which old titles get made into DCPs. Naturally, it will be a fraction of what they own.

Tarantino owns the New Beverly art house cinema in Los Angeles, where they still use 60-year-old projectors, but his problem will soon be what to show.

If film is dead, how come the new Star Wars movie is being shot on film, not digital? That’s right: JJ Abrams will reboot the series with the bold and beautiful photochemical process that filmmakers have used for the first 100 years of the medium.

Why? I blame Jar Jar Binks. George Lucas so loved the excitement of digital that he almost killed his own legacy with Binks, the first fully digital lead character in a Star Wars movie (Episode 1, The Phantom Menace). Binks showed how awful a digital future might be, and the next two movies – shot on digital cameras – confirmed it. Abrams is taking the series back to film to reconnect it to the look and feel of the original trilogy. To make it real again, in other words (irony intended).

Now we’re at the nub.  A film is a physical artefact, something that can be projected, transported and stored. Shooting on film is expensive, so directors have to be careful. Light it badly and the shot is ruined. Digital frees the director to shoot as much as she wants, both a strength and a weakness. The director need not be as careful; colours and palette can be altered in post-production. Digital editing is faster than on film, so endless variation is possible. The director doesn’t have to know what he wants; the editor can just keep redoing it. Discipline and foresight are not as important. Digital is forgiving, film is not.

Doesn’t that mean digital is a better way to make films? No, it’s just easier, and some think that’s a bad thing. When film was hard and expensive, it kept the riff-raff out. Now anyone with a Canon 5D and a Macbook can make a film, and they do. Digital has democratised the process and at the same time degraded it.

A few major directors hold out, Christopher Nolan being the best known. The director of the Dark Knight trilogy and Inception works only in celluloid, and he preaches the gospel. “Film is the best way to capture an image and project that image,” he told an audience of theatre owners in Las Vegas this year. “It just is, hands down. That’s based on my assessment of what I am seeing as a filmmaker.”

He’s not alone. Even as the film labs are disappearing, some hip young directors cling to film. They like the way it looks, the beauty of the grain, the subtlety of its larger dynamic range, the concreteness. The Melbourne International Film Festival this year even has a strand dedicated to films shot on film.

Archivists are terrified of a digital future, in which digital formats come and go with frightening rapidity. The Los Angeles Times reported in 2012 that the original files of Toy Story 2 were erased by mistake at Pixar. The film was saved only because one of the key personnel had taken a copy home, to work on it.

Film prints don’t erase themselves. If they are stored properly, they will last well over 100 years.  We’ve already lost a huge amount of the world’s film heritage, through lack of care. The digital universe looks like making that worse, not better.

On Twitter:@ptbyrnes

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Scott Morrison at odds with Christian boast

Posted on 16/11/2018 by

Illustration: Reg Lynch.MORRISON’S SHORT MEMORY
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In a week where Immigration Minister Scott Morrison has been accused by no less than the Australian churches of “state sanctioned child abuse . . .” for what is happening to refugee children under our care – self-harm is at epidemic levels, with 128 cases reported in the past 15 months, and that is just for starters – it is apposite to recall Minister Morrison’s maiden speech in Parliament in 2007.

“From my faith I derive the values of loving kindness, justice and righteousness, to act with compassion and kindness, acknowledging our common humanity and to consider the welfare of others; to fight for a fair go for everyone to fulfil their human potential and to remove whatever unjust obstacles stand in their way . . . Desmond Tutu put it this way: ‘We expect Christians . . . to stand up for the truth, to stand up for justice, to stand on the side of the poor and the hungry, the homeless and the naked, and when that happens, then Christians will be trustworthy believable witnesses.’ These are my principles . . .”

Takes your breath away, doesn’t it? And I ask again: Is putting kids in detention what Australia really wants?

ROASTING THE TURKEY

Love this. At a speech early this week marking the end of Ramadan, Turkey’s deputy prime minister, Bulent Arinc, noted: “A man should be moral but women should be moral as well, they should know what is decent and what is not decent. She should not laugh loudly in front of all the world and should preserve her decency at all times.” Turkish women were not impressed and, most wonderfully, cranked up social media to mock the comments, often accompanied with pictures of themselves laughing uproariously under the hashtags #kahkaha (#laughter) and #direnkahkaha (#resistlaughter). The whole thing has taken off. The fallout as feminism continues to meet Islam will be fascinating in coming decades.

EMAIL GAG OF THE WEEK

This bloke from up the back of Bourke, see, has just finished loading a couple of cartons of beer into the back of his ute and is just about to start the engine when he’s approached by an extremely attractive young woman who asks him if he’d like to swap beer for sex. He looks at her for a few seconds and then says. “What sort of beer have you got, love?”

WOMAN IN BLACK

As you may have noted, “a mysterious woman, shrouded in flowing black robes from head to toe,” has captivated America in recent weeks. A kind of slower female version of Forrest Gump, the 50 year old has been walking from the swamplands of Alabama to high in the Appalachian mountains in West Virginia. She doesn’t wish to talk to anyone, she just wants to be left alone. Her story appears complex, but among other things she is a widow, and a veteran. Sydney had something similar, on a smaller scale nearly a century ago. She was a woman in a long white dress who ever morning would make her way down Glebe Point Road, up Broadway and down George Street as she made her way to Circular Quay to see if this time, this time, her son had returned from the Great War. And he never did. The centenary of the beginning of that terrible war, is of course tomorrow.

KEEP THE FORESHORE FREE

Back in 1998, when the then Prime Minister John Howard was asked his view of cutting off parts of the Middle Head wonderland to private development, he was frank.

“I find it very unattractive,” he said. “The Harbour foreshores of Sydney [are] a jewel in the Australian crown.” Who could argue? It is a wonder of this city that such public land has been preserved over the centuries. And yet now, there really is a move to sell off part of it to build a facility for aged care. Mosman does not turn out lightly for protests, but it did last Sunday with force, 350 strong, and rightly so.  Watch this space. This is a stink the government doesn’t need.

THEY SAID IT …

“State sanctioned child abuse . . .”

The summation of a group of Catholic and Christian church leaders, the Australian Churches Refugee Taskforce, in a report on the Abbott government’s immigration detention system.

“Keeper has tooth puncture wound but is fine. Juma the tiger’s good too.”

Statement from Australia Zoo, on the Gold Coast, after a keeper was bitten by Juma, one of the zoo’s tigers.

“If you need to dispose of anything you shouldn’t have, we suggest you flush it now.”

Jetstar crew member advising Splendour in the Grass festivalgoers to dump their drugs before landing in Sydney, saying that there were sniffer dogs and quarantine officers waiting at the domestic terminal.

“Thank you for caring for your Splendour passengers. Very thoughtful and kind thing to do. Hope the staff member will be promoted.”

Comment posted on Jetstar’s Facebook page. In fact, Jetstar punished the staffer and publicly apologised.

“There is a small possibility that something still survived. The people of Donetsk were first at the crash site and if somebody survived maybe they have taken them.”

George Dyczynski, who believes that his daughter Fatima somehow survived the MH17 crash.

“Just for the record, I sign thousands of things every year. 99.9% of them are used for charitable purposes. I am a strong supporter of human rights and for me to be positioned as otherwise because I signed a cricket bat is totally wrong.”

Brett Lee, on Twitter, after he and fellow former cricketer Glenn McGrath came under fire this week because Immigration Minister Scott Morrison gave cricket bats they signed to two Indian ministers as part of a deal the government made concerning 157 asylum seekers.

‘‘[Businesses] will be inundated. It’s an embarrassment for everybody and it’s going to make people angry. The small business person might be having a lousy day and no customers are coming in, but she’ll be getting job seekers. In the hospitality industry most of the time you know straight away whether someone can pour a cup of coffee. You don’t want that person coming back month after month.”

Peter Strong, of the Council of Small Business of Australia, about the government’s plan to make the unemployed apply for 40 jobs a month.

“I think given the response of businesses, big and small to the proposal, it’s dead in the water.”

Senator Nick Xenophon about the plan.

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US border protection panel

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BY THE NUMBERS
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Stateside

57,000+ – Number of unaccompanied minors from Central America caught crossing into the US since October 2013. Thousands more have been detained with their parents or other adults. Untold thousands have escaped and disappeared into the US.

90,000 – Estimated number of unaccompanied minors from Central America who will attempt to cross by the end of September.

24,668 – Total number of unaccompanied minors from Central America caught crossing into the US  in 2013.

13,625 – Total number of unaccompanied minors from Central America caught crossing into the US in 2012.

150,000+ – Unaccompanied minors from Central America fleeing to the US in 2015, an Obama administration estimate.

2,000,000+ – Number of undocumented immigrants deported during the Obama administration, a sharp increase over president Bush, earning Obama the title “Deporter in Chief” from some immigration advocates.

$US800 million – US spending since 2008 to improve policing of arms and drug trafficking and organised crime in Central America, a figure dwarfed by spending in Iraq, Afghanistan, Egypt and Israel.

The other side

65 – Per cent of Hondurans living at the poverty line.

70-74 – Per cent of the coffee crop in Guatemala and El Salvador affected by a fungus epidemic related to higher temperatures. Coffee is Guatemala’s top export and is a major cash crop for El Salvador.

90.4 – Murders per 100,000 people in Honduras, the world’s highestby far. El Salvador at 41.2 and Guatemala at 39.9 rank fourth and fifth in the world murder rates.

169 – Murders per 100,000 people in San Pedro Sula, Honduras, the most dangerous city in the world.

11.3 – Murders per 100,000 people in Nicaragua, about eight times lower than the Honduran rate.

178 – Total number of Nicaraguan children caught trying to cross into the US from October 2013 to end June 2014.

16,546 – Total number of Honduran children caught trying to cross into the US over the same period.

Sources: Centre for Gender and Refugee Studies and Kids in Need of Defence, United Nations.

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