Credit:Illusration: Vintage Cathy Wilcox

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MEDICARE RORTS

Quantity over quality when it comes to care

Medicare in its current form is not fit for purpose. It encourages quantity over quality and, as your article reveals (The Age, 17/10), is open to rorting. I know most GPs bill faithfully but the Medicare rebate freeze, rising costs of healthcare and running a business and increasing corporatisation only encourages stakeholders to maximise their gains from the Medicare system.

Primary health practitioners did not embark on their career with the aim of spending their time navigating the myriad of billing codes and red tape. The system is crying out for reform but, as Dr Tony Webber so eloquently puts it in your article: “If one side of politics decides to make a radical change, the other side of politics can use it to beat them over the head in an election”.

With health increasingly becoming an issue of importance to voters, there is an opportunity for the federal government to explore and implement fundamental change in the Medicare system. Increasing rebates will only encourage more of the same.
Dr Chris Edwards, emergency physician, Leopold

Is it too easy to claim for fictitious procedures?

A few years ago I had knee surgery. Afterwards I went to the Medicare section on myGov and checked what claims had been made by the various participants. Among a long list, my anaesthetist had claimed about $900 for emergency anaesthesia. I subsequently mentioned this to the surgeon who indicated there was no such situation that would have warranted this claim.

Unless there is a pattern of over-charging by doctors, I assume these types of unsupported claims are just paid out by Medicare.
Robin Schokman, Doncaster

We need to move away from fee-for-service funding

Doctors rorting the system. Why should we be surprised? As a private, non-GP specialist, I could so easily add at least four fake visits to my daily Medicare claims and receive an extra $200 a day in rebates. As I do not work full-time, I would never show up on the hopeless compliance screening which relies on me being way above average with my claims.

This cannot happen in public hospitals or in Aboriginal-controlled community health centres. The specialists and GPs are on salaries, delivering comprehensive, integrated, cross-discipline care.

A move from fee-for-service funding for doctors would address most of this rorting. It would also pave the way to a funding model that encourages comprehensive, integrated, primary health care. That is what is needed as we face the epidemic of chronic disease.
Dr Tim Woodruff, Richmond

The “care plan” I did not need and never used

My former bulk-billing GP put me on an unrequested, unnecessary and non-specific care plan that I never utilised. When I realised Medicare had paid hundreds of dollars for the preparation of that plan, I left that clinic altogether.
Ros Shennan, Mentone

We need a better system of remuneration

A major problem with over servicing in Medicare is its encouragement by corporate general practice, pathology and radiology for monetary reasons and aggravated by patients’ expectations for multiple tests.

The time-based charging system by Medicare encourages “five-minute medicine” and needs to be replaced by a system of remuneration based on complexity of visits and positive outcomes in preventative care. Specific training of doctors regarding appropriate pathology and radiology tests would also be beneficial.

The proportion of doctors rorting the system is small, but virtually freezing the Medicare rebate for the past seven years has not helped. The solution, according to one former Coalition minister, is “a rort squad similar to its rort squad for the National Disability Insurance Scheme”. That aged well, didn’t it?
Sean Geary, retired doctor, Southbank

THE FORUM

And the rorts keep coming

It is raining rorts: rorts robbing Medicare, home care packages for the aged, vocational education and the National Disability Insurance Scheme. Several years ago, former chief of the Australian Consumer and Competition Commission, Graeme Samuel, described the waste of taxpayers’ money in vocational education as the “inevitable consequence” of governments funding the private sector to deliver a public good. When will we learn?
Sarah Russell, Mount Martha

Just who is the muggins?

My heart goes out to those whose houses have been inundated and face huge repair costs. But when I learn that the government will pay thousands of dollars to help flood victims – including those who do not have house and contents insurance – I begin to wonder.

As someone whose finances are solely the pension, I find it hard to pay for my insurance, especially as the premiums have gone up more than 50per cent over the past two years. I do not live in a flood zone, but I do live where bush fire is a real concern.

If there is a fire and a large part of my house is damaged, will the government come to my aid? Is it worth my while struggling to find the insurance money when I can save it and rely on the government? I am beginning to wonder whether I am a muggins.
Martin Shaw, Mirboo North

Faster, more efficient

Isn’t it time we considered portable, mechanical sand-bag filling and stacking onto pallets to be delivered by forklifts on an industrial scale in a more timely fashion? Sand bagging might also be aided by sliding roller racks to shorten the distance the bags have to passed down the line or carried.
David Baylis, Drouin East

Protect flood-prone towns

Adequate levees to cope with major rain events should be considered seriously for Victoria’s many flood-prone towns. As with all infrastructure projects, cost-benefit analysis should be undertaken, but it seems likely that the prevention of huge, periodic disruption to homes, businesses, livelihoods and service provision would substantially outweigh the costs of construction.|
Andrew Trembath, Blackburn

The need for more walls

The Victoria Racing Club was astute in having a wall built around much of Flemington Racecourse to protect its asset. On the other hand, councils with an eye on income from rates were remiss in historically allowing urbanisation on the flood plain, undoubtedly against the advice of the urban planners they employ.

Councils in the area of the Maribyrnong River failed to protect their potential assets. Why was no wall equivalent to the VRC’s wall built on the other side? Oh, too many houses in the way. If governments can build walls along freeways they can, and should, build properly engineered flood levees/walls where they are most needed: adjacent to flood plains.
John Whelen, Box Hill South

Too late off the mark

Our politicians have been well and truly asleep at the wheel. The response to COVID-19 and recent floods are evidence of inadequate preparation for emergencies. I would suggest state politicians are being paid under false pretences. I hope the “teal” independents are elected at the election because our major parties need a big shake-up. Politicians are supposed to represent the people and, in my opinion, they have failed dismally.
Nadine McMaster, Port Melbourne

No fun for our wildlife

Every year I dread Halloween decorations going up. I am not a killjoy but I have seen the result of these supposedly “fun” decorations and what they do to our local wildlife. Last year on my evening walks, I witnessed the carnage caused by fake webs. Hundreds of small creatures unknowingly became entangled in the clouds of microplastic thread.

I tried to cut out bees, butterflies, small lizards, even baby birds and baby possums, which were entangled and without any hope of rescue. These micro threads wind around their little bodies, and they died an agonising death of exhaustion and overheating as they tried to free themselves. These products should be banned and the public informed of their deadly effects. Halloween is not fun for wildlife.
Katharine Balson, Hampton

Fun and games with trains

V/Line commuters must be frustrated/amused to learn that the new Cobblebank and other stations on the Ballarat line are to be extended, while the six-carriage trains are regularly reduced to three for any number of reasons. There seems to be an urgent need for more reliable six-carriage rolling stock.
Ross McIntyre, Buninyong

The haves and have-nots

Yesterday’s Age had two articles which illustrated the social divisions in our society. First, “Households doing it tough on food” explained that 32per cent of households with mortgages were struggling to put food on the table, and that Foodbank provided food to 100,000 Victorians every two days.

On the following page, “Living the high(rise) life – hotel luxury at home”. With more than 2million households nationwide experiencing severe food insecurity in the past year, does anyone believe that the trend towards hotel-like apartment living will solve the housing crisis?
Angela Woolard, Mordialloc

When teachers taught

Re “Students and teachers losing out in planning overload” (Comment, 17/10). In my career as a biology and science teacher, I had access to excellent resources such as the Australian Science Education Project and Biology, The Web of Life. These had factual information pitched at the appropriate level, practical experiments to do, and ideas and concepts to discuss in classrooms. Each topic had review questions for the students to answer.

I was able to focus on students and their learning instead of wasting hours preparing lessons that would only repeat lessons that others had done countless times before me. Then along came “school-based curriculum development” and teachers’ workload increased exponentially.
Peter Hendrickson, East Melbourne

Dangerous appointments

The right-wing coalition that won the recent Italian election has appointed two problematic men to the second and third-highest parliamentary offices. The President of the Senate, Ignazio Benito La Russa, has never disavowed his neo-Fascist past, and the President of the Chamber of Deputies, Lorenzo Fontana, is openly pro-Vladimir Putin, anti-European Union and homophobic.

As an Italian-Australian dual national, I wonder if Australian diplomats could diplomatically point out to their Italian counterparts how dangerous these appointments are for Italy’s reputation as a trustworthy member of the EU and a supporter of human and civil rights.
Mirna Cicioni, Brunswick East

Service? What service?

To save banks having to process cash transactions for customers, they introduced ATMs. Now there is a “branch reduction” policy with ANZ, Commonwealth and Westpac having exited South Yarra in recent times, taking their ATMs with them. So much for that service. Yesterday, needing cash, I walked to the Prahran branch of my bank only to find that all three ATMs were not operating – and the branch was closed.
Peter Alexander, South Yarra

Vladimir Putin’s mindset

Apart from preserving the “integrity” of the Russian empire, perhaps the invasion of Ukraine is also for the oldest reason in history: to gain land for the wealth that can be derived from food production as they, and we all, face the end of the era of fossil fuels.

The imperative for Russia to replace fossil-fuel revenue with a future-proof export industry can be instantly acquired from the appropriation of Ukraine.

I am surprised that this “obvious” motivation does not seem to be recognised by the West in its understanding of Vladimir Putin’s mindset. If this is a factor, then it might also be used for the “off-ramp” and negotiation.
Louise Bennett, Hampton

Deal with the root cause

Your correspondent (Letters, 17/10) suggests we need to invent a substance that, when sprayed or painted on, will enable graffiti to wash off in the next rainstorm. Surely a better solution would be to invent a substance that, when sprayed onto a graffiti “artist”, would result in them being washed away in the next rainstorm. This would be a permanent solution.
Linton Edwards, Ivanhoe East

Let the citizens decide

Peter Hartcher’s article – “The case for citizens’ assemblies” (The Age, 15/10) – was one of the highlights of the weekend reading. What a wonderful way to deal with problems that politicians find difficult to face. The fate of asylum seekers, especially those who arrived by boat, is such a situation.

Our navy has stopped the boats but we continue to punish those who are already here, some for more than 10 years. How hard is it to judge if they are genuine refugees? Are we going to send Afghanis, for instance, back to a Taliban-controlled Afghanistan?

A fair thing would be to give amnesty now to those judged to be genuine refugees. But the major parties are not prepared to take up the issue. A citizens’ assembly might be the way through.
Eric McKay, Camberwell

The world must act now

At 77 years of age, and facing 26 years in jail on what are obviously trumped-up charges, is the 1991 Nobel Peace laureate Aung San Suu Kyi, destined to die in prison (World, 13/10)? Surely something should be done.
Chris Burgess, Port Melbourne

Our new era begins

What era will likely succeed the just-concluded Elizabethan era? The Charlatan era.
John Rosenbrock, Mount Martha

AND ANOTHER THING

Credit:Illustration: Matt Golding

Floods

Wasn’t this country on fire a few years ago?
Jen Gladstones, Heidelberg

Do the privileged in the VRC committee room care about the unfortunates mopping up their ruined homes outside the wall?
Arthur Pritchard, Ascot Vale

Thank goodness for Dan and his Mickleham quarantine facility.
Barbara Greenaway, Mount Eliza

Politics

Thank you, Bill Wyman (Comment, 17/10), for “myrmidon”: the perfect word for Donald Trump’s minions.
Bill Cleveland, Kew

One Marxist aspiration seems to have been forgotten by Xi and the Chinese Communist Party: the withering away of the state.
Christine Weatherhead, Glen Waverley

Leunig’s “Q & A with Redback Spider” (15/10) stands alone – but what a delicious take on Truss’s “beheading” of Kwarteng.
Barbara Sharpe, Heidelberg

If public servants fly business class on short-haul flights, they should pay the difference between economy and business themselves.
Marie Nash, Balwyn

Will Albanese be like Gough and spend it all?
Peter Johns, Sorrento

Furthermore

For too long our road maintenance budget has been used for “safety”, wire-rope barriers rather than looking after the road surface.
Bernd Aberle, Southbank

It turns out that some doctors suffer from human foibles (17/10). Now to find a pill for that.
Tony Haydon, Springvale

Off-field behaviour denied Warne the captaincy. Warner, despite his appalling on-field behaviour, is to be rewarded. It’s just not cricket.
George Reed, Wheelers Hill

Samuel Johnson’s sublime, life-affirming account of his near-death experience (14/10) brings to mind the aphorism, what doesn’t kill you makes you stronger.
Harry Zable, Campbells Creek

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