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A Response to an NDIS Opinion Piece

Today Prime Minister Julia Gillard introduced the legislation for the National Disability Insurance Scheme. This Medicare-like scheme is a very important reform, a long time coming for people with a disability, who have suffered under inadequate and differing support regimes from state-to-state. The NDIS will create a national framework under which the needs of those with a severe and permanent disability will be met.

The introduction of the legislation in the House of Representatives is just the first step. NDIS trial sites will be launched next year, but there is still a need to keep the pressure on, to ensure that the fully-fledged system will be realised.

Up until recently, most of the negative debate around the policy has been about the cost. It is significant, requiring approximately $15 billion a year from the first full year of implementation in financial year. That time comes at the end of this decade. But the scheme can and must be funded. There are numerous ways to ensure that it is fully funded.

This week, in an opinion piece in The Australian written by Doron Samuell from SR2 Healthy, relatively new arguments came to light.

In the first instance, Mr Samuell argued that, “lured by the promise of taxpayer dollars, it is inevitable that disability services will come to be dominated by large, corporate players in the post-NDIS world.”

Later in his op-ed, Doron Samuell provides an argument which says that this is already occurring. So really, what we will have is the status quo. It is hard to envisage that smaller providers could be crowded out even more than they already are.

For equipment, like wheelchairs and other mobility aids, disabled people will most likely choose to use bigger organisations that might have the capacity to carry a broader range of stock and therefore, more cost-competitive products.

For services, users will probably choose to use a mixture of smaller, community-based organisations and larger “corporatised” ones. This will, again, at least maintain the status quo. There is also a strong chance that smaller organisations able to adapt to client needs under the NDIS will be able to grow if they can prove they provide good services.

The idea of the insurance scheme, as it will apply to many applicants, is to give users, capable of decision-making, the choice to pursue services from providers that they perhaps already identify with.

Also on the question of choice, Samuell made what amount to some pretty offensive, not to mention inaccurate comments about the capacity of people to choose wisely under the disability scheme. He actually claimed that the disabled were “often unsophisticated” purchasers and asked “these consumers going to make the right decisions?”.

Well, of course those who have a capacity to make decisions for themselves are overwhelmingly going to make the right decisions according to their needs. People with a disability are no less rational than ‘able-bods’ and nobody else knows their personal requirements better than people with a disability themselves. No doctor, no healthcare professional, no bureaucrat understands disability better.

Mr Samuell also appears to have forgotten a provision in the bill, which allows for funds to be provided to a carer or directly to a service provider in the event that someone eligible for NDIS funds is unable to make or communicate decisions for themselves on their own care needs. The latter is a worry because, again, bureaucrats should not be making these kinds of decisions.

Samuell also states that “the NDIS will need to ensure that buying decisions are scrutinised, audited and reviewed”. The legislation actually provides for this.

Doron Samuell does go to the question of funding. He does this from the position that Medicare, the system that the National Disability Insurance Scheme is based on, is under-funded and has a bloated bureaucracy.

There is a danger that the NDIS will be under-funded. There is always that danger when government embark upon significant reforms, that costs might be under-estimated. But what is clear is that the claim about Medicare only coping “by progressively lowering the standard of care to maintain its universality”, will almost certainly not apply to the NDIS.

A bloated bureaucracy is of some concern. There will need to be a significant number of  jobs created or filled across the states  and territories to oversee the agency. However, the bigger concern should be too much centralisation of the increased bureaucracy.

Finally, Samuell’s contention about the NDIS not being based on insurance principles is neither here nor there. What is important is that this landmark reform provides adequate support for those it is targetted at.Getting bogged down in definitions is pointless.

The biggest concern should be making sure the introduction of the full scheme occurs in 2018-19.

Fat-Fighting Mission Will Continue to Fail With Labels

It has emerged from a Lateline report last night that an agreement has nearly been reached between public health experts and food businesses for a new food-labelling regime. The system, if adopted, appears likely to be legislated by government in 2013 in a bid to arrest the growing obesity epidemic in Australia.

It had been hoped by those involved in public health that a s0-called ‘traffic light’ system would be adopted for use in the fight against obesity.

This system would have seen processed foods labelled with either green, orange or red dots. Under this scheme, if a product had a green dot it was perfectly okay. If food had an orange label it would have meant ‘be careful, this food is just a little on the naughty side’. Red would have meant, ‘danger, danger, you are clogging your arteries as we speak’.

Instead, the purported compromise would see a ‘star system’ pursued on labelling of processed foods. This idea would be much like the way that movies are often reviewed. There would be a five-star system and the more stars there are, the better the product for you in terms of health.

Ostensibly, both the star system and the traffic light solution are meant to be quick and simple ways of identifying foods that are good, bad or downright dangerous if consumed too much. Frankly though, neither of them actually understand the obesity problem and the reasons for it, nor will colourful marks or star-charts actually help the obesity problem.

Neither the stars nor the red, orange and green ‘lights’ would say how much of a product should be consumed. Of course, if you’re only eating foods with green and rarely orange or red, then this probably will not matter so much. It still is possible however, for people to become overweight through lack of exercise despite some pretty healthy choices.

In this way the Recommended Dietary Intake, or RDI labelling of foods clearly trumps the other two methods advocated by health lobby groups. This form of nutrition information shows the fat, salt and sugar content at the very least and gives a very handy outline of the proportion of these elements in terms of the recommended consumption of the average person.

It is the clearest way of labelling how much of a particular product the average person can consume before it becomes over-consumption and would not leave people confused as to how much food any given person could digest in a relatively safe manner.

But of course, there is a problem too with foods that have the RDI on the packaging and that is time, a point acknowledged recently in response to the fat tax in Denmark failing to work. This is not about how long it takes to eat food, but how long it would take for people to add up the numbers. People are time-poor, and because of that, any form of labelling will effectively be redundant.

Time is also an important factor in the sense that fast food, more often than not, unhealthy, is much quicker for people who are busy with work and other commitments.

Other issues relating to ease of access are also an important part of the equation when thinking about how to cut the fat. Both the prevalence of unhealthy foods and the low costs are significant impediments to a healthier Australia.

The time has come to think past fancy labelling and other government-imposed nonsense. Those kinds of policies, despite supposed research to the contrary, simply will not work.

However, if any food labelling has to continue to exist, then it should be based on the RDI of fat, sugar and salt in particular. This appears set to be superseded.

Question Time Ahead of Time

The end of the parliamentary week is upon us and hasn’t it been an extraordinary one? The hostilities have persisted throughout the week, not letting up even in the days after the speech to parliament by the Member for Dobell, Craig Thomson in relation to allegations of misuse of union funds. Indeed the week in Canberra is far from over though only a matter of hours remain in probably the biggest, most acrimonious week Australian politics has seen in a long while.

One more day of parliament for the week means another testy hour or so of Question Time ahead from 2pm this afternoon, perhaps even less if the now regular feature, the suspension of Standing Orders gets another run, which you’d have to say on the balance of probabilities is almost a sure bet.

The Coalition will almost certainly continue with their two-topic attack which has tended to be the way forward in Question Time for the Opposition for a very long time indeed. This strategy will see the Abb0tt-led Coalition almost certainly proceed full-steam ahead with questions surrounding the carbon price which with each day that passes nears its commencement date of July 1 this year.

The Coalition will also, despite moves this week to quell the matter, including allowing the referral of Craig Thomson to the Privileges Committee be likely to pose a not insubstantial number of Craig Thomson related questions to the Gillard Government. It is also incredibly likely that despite the Thomson matter being referred to the Privileges Committee that a further suspension of Standing Orders related to the matter (and it has been the subject of a few) will occur.

The ALP Government’s Question Time strategy is completely predictable too and has been regularly based around the same broad topic, albeit in different guises also over a significant period of time.

The overwhelming focus of the Gillard Government in Question Time has been the state of the economy, both in domestic and internationally comparative terms and that has been outlined and worked on over many months.

The current specific focus in relation to the economy is all about the budget and the spending associated with it that Labor says will assist low to middle income earners  and their families particularly with the cost of education through the taxes reaped from the mining boom.

The government in also prosecuting a projected return to surplus of the budget that Wayne Swan handed down just over two short weeks ago amid what almost equated to  acceptance that the government had already returned the budget to surplus when it has not in fact done so and will not in fact do so until the end of fiscal year 2012-13 on June 30 next year and we may not know for sure until even later than that.

There is also a very real possibility, with unforeseen spending requirements and further revenue write-downs among other factors that the idea of a $1.5 billion surplus a bit of a struggle.

Question Time as always begins at 2pm and promises to be a heated contest that will offer no respite until about 3:10pm when the Prime Minister will ask that “further questions be placed on the notice paper”, unless of course the suspension of Standing Orders has brought questions to an earlier close.

Costings for Many Projects But Not the NDIS Until Tomorrow

Last week, to the excitement of many people with a disability and their parents and carers, the Prime Minister announced that in the budget to be delivered by Treasurer Wayne Swan tomorrow evening, the government would be allocating funds for a total of four “launch sites” to begin to deliver the Productivity Commission recommendation of a National Disability Insurance Scheme. In making this announcement, the Prime Minister Gillard has hastened delivery of the policy to a full year earlier than outlined by the Productivity Commission in its recommendations on the matter.

In announcing the intention to deliver this funding allocation in the budget, the Prime Minister told the Sydney rally that they and other Australians with a stake in the policy would have to wait until budget night for further details, including the most important part of the package, the funding itself required to deliver the promise to reach 10,000 Australians with a disability beginning in July next year.

This, in light of the other budget announcements made by the government should be raising eyebrows in query of why one particular group has to wait until the budget is delivered to find out just how much it might cost when other announcements made have had costs attributed to them.

There are various projects that the government has announced, both new spending and cuts where practically full detail has been outlined, compared with the NDIS which has been teasingly announced, but lacks in detail on both cost and locations.

What we do know is that the ALP Government have, for some weeks and months now been holding the NDIS up high as very important and often placing it, if by words only at this stage, at the centre of their policy agenda and political communication with the electorate.

This could have much to do with the fact that the initiative is set to help over 400,000 Australians and their families to deal with the astronomical costs associated with having a disability including equipment and often regular rehabilitation. That’s a lot of votes that a government so on the nose with the public could do well to attract even though it would appear to be just in order to “save the furniture”.

So perhaps announcing the exact details of costs for the project on budget night would be in order to create great fanfare? Put a positive spin on a budget which is supposed to be tough and replete with cuts and budget tricks?

The in-principle support of the states is not without question and that could have something to do with the lack of detail released which would include negotiating where to commence the scheme and whether the states would be stumping up funds for the trials beginning next year.

Whatever it is, people with a disability have waited long enough for policy that will assist them when they cannot help themselves and will allow many to be able to fully participate in the basic daily activities that most in our society take for granted.

In any case there is not much over 24 hours until the detail is announced and interested stakeholders will certainly be watching closely to see whether they might get to test the new framework in just over a years time.

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