Cutting Bulk-Billing Incentives

The Mid-Year Economic and Fiscal Outlook that was released in December has created waves of outrage as Australians realised exactly how $3.7 billion worth of cuts to health, aged and welfare sectors will affect them.

Croaky has a great breakdown of where some of the larger cuts are coming from in their article MYEFO: Making Healthcare More Expensive and Less Accessible for many.

But the one that has garnered a lot of attention, particularly from women, people with disabilities and those living with chronic illnesses, is the $650 million (over four years) that is being gouged from the bulk-billing incentives of pathology, diagnostic imaging and MRIs.

It is worth noting that it is only the incentives that are being cut, not the medicare rebate itself. These incentives are a small “bonus” (up to $3.50 per pathology item, an extra 10% of diagnostic imaging and an extra 15% of MRIs) that is paid to the provider to encourage them to charge exactly the medicare rate, so there is no out of pocket charge to the patient. Whether the incentives have helped to keep many pathology tests available for bulk-billing patients is debatable, but the proportion of bulk-billed diagnostic imaging services increased by 10% when the measures were introduced.

These new cuts have been called “another co-payment by stealth” and are just the latest in the Liberal Government’s efforts to “cut government health funding and pass costs on to patients“.

The question now is who will absorb the cuts and how?

There has been some hopeful talk from the Health Minister’s office about the costs being absorbed by the pathology companies, but these are large, private, multi-national companies with a bottom line to consider. As an example the reduction of the bulk-billing incentive from 10% to 5% for diagnostic imaging is a profit reduction of 4.5% for the company. This is loss of 4.5% every time, on every service, with no reduction in any overheads or any way to make up the money lost unless they pass on the budget cuts and start charging an out-of-pocket fee for some or all services.

I am a chronically ill person. I live on the disability pension, and every year I have many, many tests to check my health. These range from mris to blood tests to urine tests. Even with the current level of funding for medicare I still spend over a thousand dollars each year on my healthcare, and that’s not including the rebate money that I get back from medicare, or the money that my generous parents give me to help cover some of the larger costs.

Good healthcare shouldn’t be a privilege for those with money, it should be available to all. Eroding medicare services is just one more blow to the widening gap between the haves and have nots.

The money is there. We have a very low tax rate, low debt, and are funding ridiculous tax breaks for the super-wealthy and international corporations. This is not an economic decision, just one more ideological choice that shows the isolationist and callous nature of the Liberal Party’s values.

What can you do?

Sign this Change.org petition and show the government that they are not representing the will of the people: Australians want free and comprehensive healthcare to promote good heath among our citizens, to help reduce the financial burden of preventable disease, and most of all to protect our most vulnerable – the chronically ill, the disabled and those living in financial difficulty.

Write this letter to Health Minister Sussan Ley via The Australian Greens. Although it is a women’s issue campaign, they highlight that: The decision to cut funding won’t just affect women – it will affect young people getting STI checks, people with chronic diseases like diabetes, and could mean diseases like cancer aren’t caught as early.

Vote with your feet – join a political party that values healthcare, and write to your local member explaining your choice. Follow these budget cuts as they go through the Senate and make sure your voice counts.

Read this great article from Paloma Brierly Newton, who explains why “the cuts and the costs to women’s health services are not only socially outrageous but also personal.”

Money-No-Object Objects

The Spoonie life is a hard life – no matter if it’s Multiple Chemical Sensitivity or Chronic Fatigue Syndrome or Lyme Disease or Chronic Pain, having a condition that severely limits your mental and physical capacity is all sorts of devastating. It’s also financially devastating because being unable to work generally diminishes your income to somewhere between nothing and whatever government pension is available to you. (Assuming you live somewhere lovely like Australia, where getting onto the disability pension doesn’t include hiring a lawyer)

Still, living on a limited income doesn’t mean I can’t dream, and with assistance from my parents I even have a few of these quality-of-life enhancing babies!

Air Filter

MCS is one of the reasons I have so much fatigue – The IQair Healthpro 250 is a great air filter that gets rid of the VOCs I’m sensitive to as well as dust and mould. I use it in the bedroom at night and reducing my exposure in this way has helped me improve. Any sort of air filter will be useful, but the absolute King of air filtration is a system that you can hook up to your ducted air system like this one from IQair.

 

Sauna

If Santa ever wins the lottery he can deliver one of these straight to my door. Infra-red heat is divine on a bad fibro day, and saunas are one of the few proven ways to help your body detox. Quality is really important in a sauna though, as some models use glues or wood preservatives that give off toxic VOCs. One idea that I love is a half-body sauna which means you can do some reading/computer work while in the sauna. Mmmmmmm!

Car

There was a time when I was so ill that any driving was out of the question for me, but once I got a little better I was surprised to find that driving was much easier for me than catching public transport, especially for short distances. Walking to a bus or tram stop was too far, and standing to wait for any length of time was not doable. The car meant no exposure to the elements (wind, rain, cold or heat was too much for me to deal with) and much more control over the volume of noise (sudden or sustained loud noise would trigger the dysautonomia). It also meant that I wouldn’t be close to people as I was super anxious about crowds (and the anxiety would trigger the dysautonomia) and in an emergency I could recline the chair and rest while the cavalry was called in. The downside meant that if I overestimated my energy levels I would either become stranded and unable to drive myself home (which happened a few times), or I would be behind the wheel while I was mentally and physically unfit to drive (which, I am very sorry to say also happened a few times ).
For Spoonies, if they can safely use a car, doing so is made much easier by having the following extras:
Automatic; shifting the gears and using the clutch can be too physical
Power Steering; an essential for those who tire easily
Cruise Control; This makes the long highway drives so much easier
Climate Control; seriously important for anyone with dysautonomia
Chauffeur; hey, if money was no object….

Bath

The forest views help with the CFS…

Mmmmmmm, I am lucky enough to be renting a house that has a bathtub and it is divine! The bath soothes my fibro joints and muscles and being in the water regulates my body temperature and gets the blood flowing evenly throughout my body. Especially in the winter this is a huge issue as the cold exacerbates the tendency for the dysautonomia to slow the blood flow to my hands and feet.

Home Heating and Cooling

Most Spoonies will spend most of their time in their homes. The cold makes you miserable and stiff and sore and can aggravate rheumatism or fibromyalgia. The heat is sticky and gross and creates problems if you have issues with your blood volume. Constantly being either too hot or too cold will sap you of precious energy. If you are at home 24/7 running the climate control is a huge expense, but it does make living easier.

Wheelchairs/independence devices

For a while when I was living in the city I was housebound. Some days I was able to slowly walk the 20 meters to the taxi rank and catch a cab to the massage parlour two blocks away. If I had had an electric wheelchair I would have been more mobile and independent. Even just being able to wheel myself to the local park to sit in the sunshine would have made a huge difference to my life. These babies are not cheap, but they open up so much of the world.

Supplements

But wait, vitamin tablets aren’t that expensive? To someone earning less than $800 a fortnight, they are. Especially when your various doctors and specialists have recommended you take a heap of them.

Specialist and Alternative Doctors Bills

The sicker you are, the less you are able to work and the less money you are able to make. But the sicker you are the more doctors you need to see and because life has a sense of humour they are also way more expensive. The Medicare safety net goes a long way to making this more affordable, but a percentage of a lot is still way more than some people can afford.

Dishwasher

I’m really lucky – my dishwasher comes with a cooking and cuddling function! But when we were living in the city we had the real deal and it was marvelous. Stacking and unpacking a dishwasher can be arduous for some, but I found that I was able to rinse the dishes and stack it throughout the day, and sometimes even rinse and stack all the dinner dishes in one go. I could put it on every night, and then Guy would unpack it every morning. Even if you are able to do the dishes yourself, having a dishwasher would allow you to use that half hour of mild activity for something else, like yoga, or dusting, or having a coffee with friends. And if it’s your partner or carer who is stacking the dishwasher, this is something that will make life a little easier for them.

Over to you: What are some ridiculously expensive things that would help improve your quality of life?

Money, Health/Welfare Advocacy and Dr. Karl part one

I am slowly reading through the latest Dr. Karl* book, Game of Knowns: science is coming… (His book titles are as daggy as his ridiculously colourful shirts, but it’s a good read.) Chapter 23 is titled Money Magnets: the Science of Economics.  I want to share with you some excerpts from that chapter as they have brought together some thoughts of mine about money, welfare and the current political situation in Australia concerning the recent budget.

Part One: Money

Money is rarely mentioned in the chronic illness blog community. Nobody wants to complain as we all know of someone worse off than ourselves. There is a stigma attached to admissions of doing it tough financially – we don’t want money considerations to colour how our friends see us, and we certainly don’t want pity from anyone. For those fortunate enough to be supported by a spouse or parents it seems in bad taste to discuss money when you are one of the ‘lucky ones’ living in comfort and without fear. But the truth of the matter is that money is of small concern in the face of debilitating illness. Most of us can afford food; the real issue is that we don’t have the physical capacity to go out shopping for it, or to cook it when it gets home. It seems tawdry to discuss money when the best things in life are free (walking, running, swimming, gardening, chatting) and we can’t do any of them. The chronic illness advocates are (rightly) putting the emphasis on showing the world what it is like to live with an invisible illness, creating awareness and hopefully motivating funds for medical research. However, having an illness that limits your working capacity has an impact on your financial situation. This is an issue that affects all of us, and one that I would like to investigate further. The following quotes (in blue) from Dr. Karl’s book Game of Knowns give an insight into this important social issue.

“The evidence is overwhelming that poverty brings with it poor health – as well as crime and other social ills. This litany of woes includes alcoholism, heart disease, suicide attempts, chronic obstructive pulmonary disease, premature death and so on.”

As I have found, there is also a correlation the other way; that being in poor health can lead to poverty. In my case, I was previously able to work for three days a week. I was able to support myself and was financially quite comfortable – any large investments such as one day owning my own house would be difficult, but I could afford a social life and the occasional holiday. When my symptoms worsened in 2013 I could no longer work. I lost my job and became reliant on the Disability Support Pension. At $22,800 per year I am far from poverty. At only $10,000 less per year than I was making as a primary school teacher the Disability Support Pension meets my needs adequately. But I happen to be particularly fortunate in the support I have around me. I don’t pay rent and my generous parents pay for my medical bills and equipment (even with the Medicare Safety Net this is still a large amount of money). I can easily see how someone living on welfare with no further financial support systems in place to help could become very financially stressed.

Image from http://www.emeraldinsight.com/

“Another factor is the persistent stress of trying to survive as a poor person in a hostile world. In the short term, the “Stress Response” is a powerful and appropriate survival mechanism. It sends extra glucose through the bloodstream, and increases your breathing rate, heart rate and blood pressure. All of this combines so that your muscles can work really well in an emergency. And to protect you from losing too much blood in case you’re wounded, the clotting chemicals in your blood increase and the blood vessels shrink. But in the long term, the “Stress Response” can make you unwell. You suffer an increased risk of diabetes, high blood pressure and blood clots – and your immune system can weaken. And this leads to earlier deaths.”

There were a few months where I had very little to no income. Once my paid sick leave ran out at the end of March 2013 my earnings were unpredictable as I was working between one half day and two days a week. Some weeks I would earn $75, and there were a few weeks where I couldn’t work at all. At the end of June my contract ended and I was officially jobless. It took about two months before I was mentally prepared to start the fight for the Disability Pension, and another two months before I got through all the red tape and started getting a secure, regular income. Those months were just awful. Centrelink is a bureaucratic nightmare and difficult to negotiate at the best of times, let alone when you are physically and mentally handicapped. All the while, the “Stress Response” was overwhelming. Asking your boyfriend to pay for your share of the bills is mortifying. Not knowing if you are going to be accepted as ‘disabled enough’ to qualify for the Disability Support Pension is soul-destroying. Watching your savings dwindle away and knowing that there is no way to earn more money is terrifying. It was like having a constant looming presence in my chest that pressed on my heart and constricted my throat. This was despite the knowledge that my parents would never let anything happen to me, that if the worst happened, I could move back in with them and be taken care of. (In fact I did move back home for a few months.) I couldn’t imagine the consuming fear and panic I would have felt had I not had a parental safety net, but I know that this is what many people in the chronic illness community face.

This is why I feel it is important to advocate for health and welfare systems. Not everybody has a safety-net of friends and family to help them, especially as so often that help (financial or otherwise) is needed on a long-term or ongoing basis. The chronically ill are some of our society’s most vulnerable citizens and advocating for the systems and structures that support them is important. As users of these systems and structures it behoves chronically ill people to champion welfare and health initiatives and speak out about their experiences. This seems like a big ask when fatigue is a factor in most of these insidious illnesses. We are coping with so much, to add any other consideration to our plates can seem like too much. But by sharing our stories we can shine a light on how important good healthcare and welfare systems are.

In my case, I hope my story shows the value of the Disability Pension – without it I would not be able to maintain myself as an independent person and would be living solely on the charity of my parents. I also hope to show how unfriendly and unnecessarily difficult Centrelink is to deal with – their ineffectual management systems are cumbersome for customers and staff to use, and they make the process of applying for unemployment and disability services harrowing.

If you have an opinion or a story to share, please write in the comments or post a link to your blog.

*Karl Kruszelnicki is a scientist who holds degrees in mathematics, biomedical engineering, medicine and surgery. He has also studied astrophysics, computer science and philosophy. He is perhaps best known for his weekly radio appearance on Triple J (Thursdays between 11 and 12). He has an interesting collection of brightly coloured shirts.