breaking covid rules

[Warb]

Warb, you may be able to answer this.....

OK, this might get complicated!

All PBS listed medications have a government defined/agreed price. For a PBS script, that price is what the patient pays (the co-payment), however the price is also subject to a co-payment cap. The cap is $41.30 for "ordinary" patients, or $6.60 for pensioners. So, using metformin as an example, the agreed price is about $20, and that is what a patient pays, but a pensioner only pays $6.60 due to the pensioner co-payment cap. If the medication in question had an agreed price of $100, the normal patient would pay $41.30 whilst the pensioner would pay $6.60. All of these payments count towards the safety net.

With me so far?

In order allow some competition, pharmacies requested the ability to reduce that $6.60 pensioner co-payment (out of their own pocket/profit, as it were) and it was decided (the industry is government regulated) that they should be allowed to give a $1 discount on that co-payment. That's the reduction from $6.50 to $5.60.

The "safety net" is reached when the patients family (it is family, not individually based) spends a certain amount in a (calendar, I believe) year. The amount is roughly $1300 for a normal patient, $300odd for a pensioner (these numbers are from memory, pre-coffee and subject to early morning inaccuracy!). When the patient has spent that amount, the safety net kicks in and subsequent scripts are free for the remainder of the year. All the co-payments discussed above, $6.60, $5.60, and the "up to $41.30" count towards the safety net.

The added complexity is that the government agreed price does not always reflect the actual price of the medication. So for example, the metformin I mentioned above has an agreed price of $20ish, but is actually dirt cheap, costing only a few dollars, but under the PBS, the price is $20. So the option for the pharmacy is to supply the product as a "private script". Private scripts normally cover medications that aren't listed on the PBS, and are basically a way for doctors to supply medications that are outside the PBS system. So a pharmacist can in fact dispense a script as "private", and thus outside the PBS rules. This means that a dirt cheap drug like metformin could be supplied at a dirt cheap price, but would not count towards the safety net. Depending on how much medication a patient and their family takes, this might produce a saving. However it also risks them missing the safety net, which might means over the course of the year they spend more, not less! The difficulties arise, of course, when the pharmacy neglect to explain all this, the patients take the "instant savings" and then halfway through the year start to wonder why they're still paying for their medications....

Some extra notes! There are a couple of other components to the price that muddy the waters still further (of course there are, this is Australia!). There is a small dispensing fee wrapped up in the pricing, and also sometimes a brand premium if there is a cheaper generic product that the government would prefer you to have. Additionally, some medications are in fact cheaper to buy over the counter (Panadol etc.) though I'd guess most doctors wouldn't bother writing a script for them. Also Aboriginals and Torres Strait Islanders all get the pensioner prices, or free if they are themselves pensioners. Lastly, there has been some discussion on whether the $1 discount on the co-payment is in fact a good thing, and talk of it being dropped. The bottom line is that all PBS pricing is regulated, whilst dispensing things as private removes the (price) regulations but also the safety net.

As one final point, seeing as we are talking about community spirit and acting for the common good. The PBS is massively expensive, and it's budget is constantly increasing. Whilst it certainly benefits the pharmacy for people to get their medications, as a tax payer it is worth remembering that unused medications still cost the government money, and they get that money by charging income tax. If you (generic "you"!) don't need the medication, don't get it! The pharmacy regularly see's bucket loads of medications being brought back by relatives of old people who have died. They sometimes have hundreds or thousands of dollars worth of medications, yet they have still had their latest script for the same meds dispensed just days previously. We also see people getting scripts that they have no intention of taking, or things like antibiotic repeats (written by the doctor "in case you need them") when they have already recovered. They get them "just in case they might need them in the future" when they self diagnose something entirely different (risky in itself!). Whilst it's free for them, it still contributes to our tax bills!

[BobL]

I'm not so sure about that.

I seem to recall that the AMA's lobbyists* had a dust up with the pharmacy guild's lobbyists around the time Turnbull was toppled.
The pharmacy guild's lobbyists wanted to make medicines "cheaper" overall by doubling the number of repeats allowed on each script. The AMA's lobbyists didn't want a bare of that as it would mean that doctors only saw the "cash cow" half as frequently. Guess who prevailed?

I have a so called "diabetes check up" with my GP once a year but whenever I need meds for any of my "conditions" I just email my GP and he write me up prescription and next time I'm driving past his practice I stop in and pick them up. Maybe thats because I see him so often for other stuff?

[MichaelGT]

The solution to all these medication problems is to rethink and raise our consciousness levels and restructure society.
What I mean is that we are all healthy beings until we get it wrong.
Nature has all solutions for our wellbeing. If we eat natural locally grown foods in season our health will be maintained.
We can enjoy a long healthy life without many ailments.
Processed foods, frozen and transported foods are not healthy. Grow our own or use community gardens for health foods and use the local farming community.
Restructure housing so we are in smaller communities looking after each other, socially, mentally and physical wellbeing.
Financial reset worldwide back to precious metals backed currencies. No Fiat currencies printing money at will causing inflation. This will stabilise housing costs and take pressure off debt and income earning, allowing time for families to spend precious time together. with reduced working hours.
Off the couch getting exercise as a daily practice.
We would easily be able to counteract physically any pandemic because of our better health and avoid any restrictions and the need for vaccines.
This is a brief summary which could invite much more discussion and create controversy. However the principles are sound and can be easily verified with research and an understanding of the alternatives to which our current society operate.

[doug3030]

I have a so called "diabetes check up" with my GP once a year but whenever I need meds for any of my "conditions" I just email my GP and he write me up prescription and next time I'm driving past his practice I stop in and pick them up. Maybe thats because I see him so often for other stuff?

One of the most common-sense things to come out of Covid is the Telehealth appointments. Bob, your doctor is probably claiming an appointment fee from Medicare when he writes you up a script under the relaxed arrangements we are currently benefiting from.

If all I need from my doctor is new scripts or regular referrals I make a telehealth appointment and instead of going and sitting in the doctors waiting room for an hour and a half breathing in whatever diseases other patients might be breathing out, I sit at home and she calls me. She emails the scripts to the Pharmacist, who loads them onto the App and I order over the App. When I get a message telling me the scripts I ordered are ready to collect I go in and out of the pharmacy within two minutes. She also emails referrals to the relevant practitioners. Why haven't we been doing this forever? It just makes sense. I only need to go and physically see the doctor if I have a new condition, or if she needs to review me, like maybe once a year. Doctors still get paid, Pharmacists still get paid. I get the medications and treatment I need. If I am in doubt or the doctor is in doubt I can be called in to the surgery for a face-to-face consultation.

Why does it take COVID to bring in reforms such as this? It's like working form home. After a year and a half, companies are realizing that they have not lost control of their employees and they are not paying for office space. Employees are happier with the "short commute" form the bedroom to the spare bedroom. Jools is not catching filthy diseases on the train and bringing them home to me. If it were not for the deaths and suffering, COVID could have been the greatest reformer of society ever.

[Pagie]

I tried to do a Telehealth for my dentist and they wouldn't let me.

[Warb]

It's like working form home. After a year and a half, companies are realizing that they have not lost control of their employees and they are not paying for office space. Employees are happier with the "short commute" form the bedroom to the spare bedroom. Jools is not catching filthy diseases on the train and bringing them home to me. If it were not for the deaths and suffering, COVID could have been the greatest reformer of society ever.

This I disagree with. It is an unfortunate fact that the human species is inherently lazy and selfish. There are people who struggle to be better, but the majority don't, or at least may try to fool others (and perhaps themselves) but deep down are doing what's best for them. Working from home is an example of something that is too easy to abuse for most people to resist - that's why Netflix were asked to reduce video quality to save bandwidth when so many were "working from home". Unless you are a movie critic, why are you watching Netflix?

One of the reasons that I'm so cynical about this is that big pharma is a high-pay employer and therefore (in some situations) create a "luxury" work environment. 20 years ago I was involved with two different big pharma "work from home" situations. One was in the US, and it was largely accepted that "working from home today" simply meant a day off, but was genuinely part of the company policy - "they" believed that people were actually working. The second situation was just before the internet became ubiquitous, and I was involved with installing network links to people's houses so they could "work from home" using the companies network (no internet at home in those days). We monitored the use of those network links and the usage of the laptops we supplied - not secretly but we didn't shout about it either - it was (pharma, remember) in spirit a "blind study". Guess what. Almost nobody used either the laptops or the network links when they were "working from home". Sometimes people would log in for half an hour in the morning to check their email, but that was about it. The project was canned.

Now it must also be remembered that things have changed since then. A friend of mine who was working for a large IT company told me, a couple of years ago, that his staff (by company policy) got free use of their phones all day, to do whatever they wanted (not work related!), and a raft of other non-productive measures had been taken for "employee welfare" reasons. As a result, the output had dropped to almost nothing, he had twice as many staff producing half as much output, and he was just about to call it quits because he was over it. He was unable to keep his customers happy because his staff did nothing, and that (apparently) was completely acceptable to the company as long as the staff were happy. So perhaps if that is a true reflection on the modern workplace then working from home is no great loss?!

[BobL]

The GP will also do referral renewals direct to my 3 specialists without any physical appointment. This Gp is very popular. It not unusual to have an official wait time of 10 business days for an appointment but I usually keep him updated by email about any developments any let him decide if I should go see him and if required he usually sees me within a day or so. For my latest left ankle situation I have seen him once and after that I must have sent him at least a dozen email updates. He’s subsequently referred me for 3 scans. Ankle is still rubbish despite any meds we’ve thrown at it.

[doug3030]

This I disagree with. It is an unfortunate fact that the human species is inherently lazy and selfish. There are people who struggle to be better, but the majority don't, or at least may try to fool others (and perhaps themselves) but deep down are doing what's best for them. Working from home is an example of something that is too easy to abuse for most people to resist - that's why Netflix were asked to reduce video quality to save bandwidth when so many were "working from home". Unless you are a movie critic, why are you watching Netflix?

It is not the people working from home that are the big users of Netflix etc. It is all the others who can't go out and clog up the supermarkets and shopping centres or going to school/uni. Their bandwith usage was leaving very little bandwidth out of the total available on the internet for the work from home people to make use of. For example, we are on a 250mb/sec plan and when I do a speedtest through the day I generally get somewhere between 20 and 50 mb/sec. It is just enough for Jools to work from home and a little bit left for me to browse the web or maybe the music in the shed.

For most people working from home now, they log into the work network over the internet and their supervisors have many ways to monitor their activities. They really do WORK from home. Supervision could be via the PC camera/microphone, screen monitoring or monitoring their work queue and key stroke frequency. Others may be taking phone calls redirected through their link with the work network. The supervisor would know when they are logged in to take calls and if they are actually on a call. It is possible these days for the supervisor to micro-manage the worker even more closely than if they were actually in the office, and the supervisor could be doing it from their own spare bedroom. Not only can they be monitored, a recording can be made of the worker's activities for use to defend illegal dismissal charges.

The company my son-in-law works for are now saving $25 million per year in office space leasing costs and have said that they will NEVER bring their "desk workforce" back to the office. Times have changed.

Edited to add: I had also meant to say that reducing the resolution on Netflix would also help in the cases where there was someone working from home while other members of the household such as children were home from school watching netflix. There might still be people watching netflix while working form home but they would also have to keep their productivity up for the other reasons I mentioned above.

[woodPixel]

Working from home, if you've the job for it, is a fabulous innovation. It goes directly to what MichaelGT was saying.

For @MichaelGT's post above (#133), I completely agree with what you are saying, except that I feel that frozen food is a fantastic resource and reduces food waste (which is a scourge given poverty and hunger). I personally feel sugar and processed white flour are pure evil. Tasty, but cancer-causing evil.


I also feel our society has become a "cult of being busy" and work is seen as a virtue. I've disagreed with the virtues of endless pointless toil for the sake of being busy.

I'd heavily wager that if we interviewed old men on their deathbeds about their greatest regrets in life "working more" would NOT be one of them.... being with the family, having relaxed pleasurable time with friends and companions and actually seeing their kids grow up would be #1.

[Warb]

For most people working from home now, they log into the work network over the internet and their supervisors have many ways to monitor their activities. They really do WORK from home. Supervision could be via the PC camera/microphone, screen monitoring or monitoring their work queue and key stroke frequency. Others may be taking phone calls redirected through their link with the work network.

I suspect it varies with what sort of work is being done. One of my nieces works for a bank, and when the first "work from home" push happened she was able to work from home where I could see what she was doing, just by chance. Because her job, at that time, was telephone based, it was exactly as you say. She had a VPN to the bank network, all voice and data went through that VPN and therefore she "could" be monitored closely. I honestly have no idea whether such monitoring actually happens, or in fact is "legal" - these days almost anything can be seen as an invasion of privacy, I'm not sure that monitoring by camera would survive a good lawyer! In any case, she did seem to take calls, but I also noticed a fair number of breaks to get coffee. On the other hand, I suspect that (given what my friend told me about the IT company in the UK) she probably didn't do too much more when located in an office!

For such jobs as hers it's quite easy to monitor activity, but much harder for other jobs that don't revolve around voice or keyboard time. But that has always been the case. Years ago I ran a consultancy company and had some programmers that worked from home. It was interesting watching their working habits. I had one guy who was almost nocturnal, all his work, all his access to the systems, was after midnight. He did a good job so it wasn't a problem, but had his job involved any significant communication with customer or other staff it would not have been tolerable!

Overall I do agree that things have changed, but I also suspect that many people will still do as little as they can get away with, and working from home plays directly to that failing. I guess we will learn in time whether the savings in reduced office space do indeed outweigh any reduction in output (if such reductions actually happen!). Of course, given the constant decline in customer service provided by many large companies, the attitude may be "it really doesn't matter as long as it saves money".....*

*On Monday I spent over 4 hours trying to get a replacement VOIP phone from Telstra. The phone was dropped, so physically damaged and now works sporadically. It is one of those situation where Telstra provide the hardware and state that non-Telstra hardware may not work and isn't supported, so I can't just get something else. After spending nearly 30 minutes trawling through Telstra's web site and failing to find anything even remotely applicable (I can buy any number of mobile phones, but nothing else!), I decided to call their business "support" service. The first attempt to call phone support involved being on hold for 15 minutes and then the call being dropped. The second attempt involved 20 minutes on hold, followed by a conversation with someone who was very hard to understand, who kept having to put me on hold whilst he checked things with someone else, and finally (40 minutes later) told me that my local Telstra shop would be able to supply the new hardware. He was unable to help any further.... So I called the Telstra shop. They laughed and said "not a hope in hell". Next I tried the online "chat" system. This involves typing messages to someone who is clearly dealing with about 30 other chat sessions at the same time, so there is a 5 to 10 minute delay between typing and getting a response. Firstly I had to identify myself, by providing details that nobody, NOBODY, would ever know. So I had to contact "the office" and get those things emailed to me. So 40 or so minutes in, and I was now apparently authorised! Another hour or more of "ten minute lag" chat responses, during which I had to find out what hardware Telstra had supplied, because apparently they don't record such trivia, and finally a promise to post me out a replacement. "Is there anything else I can help you with today"? Damn it Warb, why didn't you quit?! Stupidly I asked if there was an online portal where I could just order the hardware from Telstra. He gave me a link to telstra.com and said "they're on there". No, no they're not, If they were I wouldn't have needed to call you. "Oh, then try your local Telstra Business Centre, here's a link to tell you where it is". Used the link, the answer is "Broadmeadow, Newcastle". 280km away, in a lockdown. Really? "Oh, well you could phone them..." OK, well thanks anyway!

I later got an email saying the order for my part was being processed. Hurrah........ The following morning I got an email saying it was out of stock, and they would email me again when it was available to despatch - no ETA, nothing. I am told (not by Telstra) that one Telstra Business Store has had this exact part on backorder for weeks, and has no hope of ever seeing it.

I eventually resorted to buying a dubious "used" one from eBay, and hopefully I can cobble it together to make it work long enough that I can move away from Telstra to a provider who at least pretend to care about their customers.

Sorry for the rant! However I guess this is relevant in two ways. Firstly it goes to my comment about "saving money" being far more important than actually working, or keeping your customers happy. Secondly, and you've probably seen this coming, THIS IS THE PHONE IN THE PHARMACY, SO THEY CAN'T RELIABLY COMMUNICATE WITH PEOPLE TRYING TO BOOK COVID SHOTS!!!

[Warb]

I also feel our society has become a "cult of being busy" and work is seen as a virtue. I've disagreed with the virtues of endless pointless turmoil for the sake of being busy. I'd heavily wager that if we interviewed old men on their deathbeds about their greatest regrets in life "working more" would NOT be one of them.... being with the family, having relaxed pleasurable time with friends and companions and actually seeing their kids grow up would be #1.

Working "for the sake of being busy" is stupid, I agree. But I'm not sure where that comes from. I've never done it; I've been paid, or charged someone, or got something that I needed or wanted in return for my work. When I've worked "more" it's because I wanted or needed something "more".

Now, in my pseudo-retirement, I work at woodturning because I want to get better. I work at farming because I want to produce more sheep, or do it more efficiently. I work fixing people's IT problems because I enjoy it (I don't even charge people any more, it's just for fun!).

I'm not certain what you mean by "turmoil for the sake of being busy".

[woodPixel]

Working "for the sake of being busy" is stupid, I agree. But I'm not sure where that comes from. I've never done it; I've been paid, or charged someone, or got something that I needed or wanted in return for my work. When I've worked "more" it's because I wanted or needed something "more".

Now, in my pseudo-retirement, I work at woodturning because I want to get better. I work at farming because I want to produce more sheep, or do it more efficiently. I work fixing people's IT problems because I enjoy it (I don't even charge people any more, it's just for fun!).

I'm not certain what you mean by "turmoil for the sake of being busy".

Sorry Warb, I wasnt explicitly targeting you. Apologies if it seemed that way. My comments are intended to be broad, generic reflections of society.

Turmoil --> toil. Typo.

[Warb]

The solution to all these medication problems is to rethink and raise our consciousness levels and restructure society.......

For most of my life, certainly my adult life, I have really wanted to believe this. I've spent many hours thinking about it, and discussing it with various people. But I always end up concluding that it can't ever actually work. Even if we accept the concept that eating correctly and exercising (etc.) can prevent disease, which I suspect is only partially true, the system always breaks down for two reasons.

Firstly, no matter how noble the intention, human greed always results in a community split between "workers" and "rulers". The rulers want ever more luxury, and the workers are required to constantly produce more for less. Doesn't matter if we're talking about Aztecs, or the communist countries, the end result is the same. The lack of equality results in unequal distribution of wealth, food, power, knowledge, with all that entails.

Secondly, regarding small communities and local food, WE BREED. As long as our life expectancy is longer than the time it takes to raise two kids to breeding age (and assuming we have two kids), our numbers will increase. That does not result in small communities, nor communities with small local food production because you can't produce a year round food supply for an ever growing population from small local farms.

If we were able to stop/control our breeding, such that communities could stay small, and we could overcome our desire to be better than our peers, then the concept might work. Sadly neither of these things seem likely, they are both genetically programmed traits "designed" to ensures that "our" genes continue in to the future.

[Warb]

Sorry Warb, I wasnt explicitly targeting you. Apologies if it seemed that way. My comments are intended to be broad, generic reflections of society.

Turmoil --> toil. Typo.

No need to apologise, at no point did I think you were targeting me! When I said "I've never done it" it wasn't a denial, just an expression of my lack of understanding. "I", and I assumed everyone else, works for gain. That is logical - I want more so I go and get more! Working to appear busy is illogical*, so I wasn't sure what you meant.

*Actually now I think about it, in the corporate world I did meet people who were "working to appear busy", but that was in fact "trying to impress the boss and get a promotion", so it's still not pointless (in their minds!). I suspect this is not what you meant though?

[GraemeCook]

Dog walking at lunch time and ran into a GP friend who basically confirmed Warb's view (Post #151 above) but added two wise observations.

ONE. Telehealth has been a boon of GPs for such things as routine script repeats, minor worries and "pre-screening" - "you do not really need to see me for that". But it is absolutely loathed by the practice receptionists; every hyperchondriac and every prescription druggy thinks that the telehealth system was designed specifically for them.

TWO. In the debate between the interests of the medical profession, the pharmacies and the public there is another hidden player in the game - the "theoretical doctors" in Health HQ in Canberra who purportedly "represent" the interests of the GPs despite never or rarely actually having practiced as a GP.