MacDoctor on benefit budgeting

April 9th, 2011 at 10:36 am by David Farrar

MacDoctor blogs:

John Key was castigated in the left wing blogosphere for suggesting that the increase in people needing food parcels was due to issues of budgeting. It seems he was right. Not that the Herald would actually use the MacDoctor’s headline – they prefer:

Mum refused food aid under tough new rules

And then they launch into a long story about a solo mum with fibromyalgia and three children (7, 13 and 17) who has had to escape an abusive relationship. So far so good – that is what the DPB was intended for (although I would have thought she would have been on the sickness benefit, rather than the DPB). The story gets lurid with the nasty National government refusing to provide this poor lady with food aid.

Only in paragraph ten do we learn that this woman is receiving $827.50 a week in various forms of government largesse. It is not until the end of the article that we learn that she has had  four aid packages in the past six months and that she refuses to attend any budget meetings with WINZ.

I note the rent for the property is $385 a week. The article does not say whether or not she has applied for a state house. Maybe she doesn’t want to move, but if she did move into a state house then the rent would be well under $200 a week.

The power bill is $65 a week. At 25c/unit, that is 37 units a day which seems pretty high.

Also worth noting that while her expenses are currently $31/week higher than her income, $83 a week is repayments and fines. So if they had been avoided, then there would be a surplus of $52 a week.

None of this is suggesting that life isn’t challenging bringing up three kids on $830 a week. I am sure it is. But the facts show that the level of taxpayer support is already very significant, and that there are cost savings which can be made.

UPDATE: The Herald today reports:

However, a Glenfield solo mother of three children who was refused a $106 food grant on Wednesday was given the money late on Thursday after the Herald reported on her case.

Work and Income head Mike Smith said the mother, “Maree”, was not refused a grant – “she walked out of the meeting before a decision could be made”.

“Last year Maree received 13 hardship payments. She owes us $1400 for money we’ve advanced her,” he said.

“She is clearly having trouble managing her finances. We want to help her with that, rather than continuing to service the symptoms of the problem with hardship grants.”

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MacDoctor on drink driving

April 12th, 2010 at 2:00 pm by David Farrar

An interesting idea from MacDoctor:

There is plenty of evidence that lowering the legal Blood Alcohol Concentration (BAC) reduces accident rates, injuries and fatalities in an almost linear fashion (at least below about 0.1%). Here is a link to the very latest meta-analysis.

The point is that the effect of alcohol is fairly linear. In fact, there is evidence that the largest deterioration in performance occurs at quite low levels of intoxication (0.01-0.03%) but this does not initially translate into increased accidents (One assumes that the deterioration – although large proportionately – is still not enough to cause a noticeable increase in risk). Because the increase in risk is quite linear, it follows that the setting of  a new BAC at 0.05% is entirely arbitrary.

And it about balancing risk to costs. If risk is the only factor we would set the speed limit at 30 km/hr and ban people from driving if they have consumed any alcohol at all.

Indeed, the Japanese have shown that dropping the limit from 0.05% 0.03% produces a significant drop in accident and fatality statistics. It will therefore not be long after a drop to 0.05% that people (particularly ED doctors who bear the brunt of traffic accident injuries) will be calling for a further drop. It is not logical to go to all this trouble to fix the legal BAC at yet another arbitrary limit. There is no “safe” level of drink driving.

Just as there is no “safe” speed to drive at. Again it is balancing risk vs cost.

The point here is that an arbitrary limit for alcohol intoxication is inadequate for determining whether someone is safe to drive. Even at a zero level of alcohol, other drugs may make the driver decidedly dodgy behind a wheel. It is also doubtful that any movement of the BAC limit, even to zero, will make any difference to the kind of people who get behind the wheel of a car with a BAC 0f 0.18%. As I have posted before, the only solution to that kind of fool is to change the current drink driving laws from a minor punishment to a draconian deterrent.

It is reprehensible that you have drivers with 10 or more convictions for being plastered while driving, and they get minor slaps on the hands.

MacDoctor has a somewhat radical suggestion. Let us scrap the legal limit for alcohol altogether. Instead, we should substitute a legal requirement to be “fit to drive”. Should you be stopped at a police checkpoint and the cop has any reason to believe you may be impaired in your ability to drive (including checking your breath alcohol), he can insist that you take a “fit to drive” test. Failure (to take or pass the test) will get you arrested. The test could be administered using driving simulators in the back of a police van (basic tests administered by cops – such as walking a straight line – are simply too imprecise).

The advantage of a “fit to drive” test is that it catches all the impaired drivers, not just the ones impaired by excessive alcohol. It also avoids the problem of the margin where the person with the BAC of 0.052% is carted off to jail, despite being only mildly impaired, and the person with the BAC of 0.048% is let go, despite being high on cannabis and a liability on the road. It also standardises the drug tests that the new drug driving laws propose – making them considerably more objective. It will also prevent people from using portable breathalysers so that they can drink “to the limit” regardless of how capable they are of driving.

This is a very worthy idea. It would probably be inefficient to make every driver pulled up randomly undergo such a test, but one could do a screening test for alcohol and drugs, and any non-zero response has to do the impairment test.

I doubt the Government will go this way, as Government like objective tests, not subjective ones. But it could go a long way towards having a less arbitrary system, where people are punished only if they are actually impaired to a level which presents an unacceptable risk.

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Dissent on making pseudoephedrine prescription only

October 9th, 2009 at 6:24 am by David Farrar

The very sensible MacDoctor disagrees with the decision. He blogs:

Unfortunately Mr. Key is being poorly advised on this matter by his science advisor, Peter Gluckman – who has no medical qualifications, BTW

The strike through is after a commenter pointed out Sir Peter actually graduated medical school, and spent two years as a doctor before going into research. He is also a former Dean of the Faculty of Medicine and Health Sciences at the University of Auckland.

Once again, I link to a real scientific study on phenylephrine and pseudoephedrine so the Sir Peter can actually read something useful on the subject. There are dozens of others, but this one is freely available to be read in full. All the scientific evidence (as opposed to the anecdotal ones) shows that phenylephrine is essentially useless as a nasal decongestant. If you want relief from your cold, you are going to have to use pseudoephedrine. All that making this a prescription item will do is make the treatment of a cold more expensive for people. It will also move the monitoring of drug seekers from the pharmacy to the GP, who is even less likely to spot the serial script seeker. “Shoppers” for pseudoephedrine will just move from doctor to doctor, gathering scripts.

Stuff also reports dissent:

The Pharmaceutical Society’s chief pharmacist adviser, Euan Galloway, said the proposed replacement, phenylephrine – which Mr Key said was a “safe and effective alternative” – was not as good.

“Ask any community pharmacist and they’ll tell you they may make one sale [of a phenylephrine medicine], but never again,” Mr Galloway said.

Phenylephrine had a very high “first past metabolism effect”, which meant most of the drug was metabolised or rendered inactive before it reached the parts of the body where it was needed.

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Mallard on Maori and manslaughter

August 16th, 2009 at 2:03 pm by David Farrar

The Herald on Sunday has alerted me to this blog post by Trevor Mallard. I have not been reading other blogs while on holiday so would have missed it. Anyway Trevor says:

I live in Wainuiomata. Like most smaller communities I know the extended Rawiri whanau, but not well.

These five people killed their niece. It happened over an extended period.

I accept that they almost certainly would not reoffend and prison may be an expensive waste of time. And there are too many Maori in prison.

But I am certain that a Pakeha exorcism that resulted in torture and death would result in a prison term – albeit not necessarily a long one.

The fact that they weren’t sent to prison because they are Maori just doesn’t seem right to me.

Almost every blog on the right has said they agree with Trevor. Interestingly I have not yet seen much reaction from left blogs.

I was actually thinking of blogging how surprised I was none of them got jailtime, and I basically agree with Trevor that it is hard to imagine an exorcism by say a church pastor with the same results would not have got a jail sentence.

In fact one of Trevor’s commenters reminds us that Pastor Luke Lee got six years jail for an exorcism manslaughter in 2001. While the cases are somewhat different it is hard to reconcile six years jail with zero years jail.

MacDoctor notes that even defence lawyer Barry Hart has said the sentences are too lenient. MacDoctor says the sentence is absurdly lenient and intensely paternalistic. I agree.

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MacDoctor on Labour and Health

June 28th, 2009 at 2:16 pm by David Farrar

MacDoctor nails it here:

If you were wondering why Labour spent so much extra money on Health without actually improving the health of New Zealanders, nor their access to services, puzzle no longer. Ruth Dyson reveals all. She is complaining that some of the health promotions that were dear to Labour’s heart have been cut or seriously curtained. Things like cancer “control”, heart promotions and the diabetes “get checked” programme. …

No, Ruth, these are NOT frontline services. They never were and they never will be. These are all Labour’s attempts at preventative health promotion and, as such, provide no health service at all. This is not to say that preventative health is necessarily useless, just that they are not frontline services. They are not delivering medicine, they are delivering social change. At least, they might be delivering this.

That is a great line – they are not delivering medicine, they are delivering social change.

That does not mean all public health activies are not worthwhile, but they are not the same thing as actually giving someone an operation, a prescription etc.

The biggest problem with all of these preventative health schemes is that no one appears to have bothered to examine whether they are making any difference. Labour’s attempt to monitor results of these campaigns (now removed from the health reporting list by National) were so wishy-washy and soft, that it was impossible to tell from the data whether they were successful. That does not seem like a good use of taxpayer dollars to me.

Take the diabetes programme “get checked”, for example. This programme, unlike most, actually has links to hard data like blood results, blood pressure readings and hospital admission rates for diabetes and diabetic complications. All the hard evidence shows that the programme has made virtually no difference to the quality of diabetic control.

Huge amounts have been spent on programmes that *might* improve health outcomes. But what data there is, is patchy.

Diabetics who normally don’t attend their regular check-ups don’t abscond because they can’t afford it, they don’t come in because they can’t be bothered. Diabetes is one of those diseases that kill you slowly, like high blood pressure (only worse). People don’t like to see the doctor unless they are sick. So they don’t. All that “get checked” does is make it cheaper for the people who would have regularly attended their doctors for diabetic monitoring. It is a subsidy for diabetics. Nothing more, nothing less.

More middle class welfare.

There is nothing wrong with this. It is just not something you want to fund at the expense of real frontline services like outpatient visits and elective surgery.

Which is what Tony Ryall is sensibly targeting.

Labour’s singular failure in health is their constant focus on what would be nice at the expense of focussing on what is truly needed.

Dead on target here.

Nobody is saying that heart prevention programmes are invariably a waste of time. We may demonstrate that they may be very useful indeed at reducing long-term heart disease. But it is not right that a dozen people should die because they can’t get heart surgery in time in order to fund a social intervention. Particularly one that does not have demonstrable benefits.

This is how Labour managed to double health spending but almost make no impact on waiting lists etc.

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MacDoctor on discipline

April 6th, 2009 at 12:00 pm by David Farrar

Read this post from MacDoctor and weep:

I initially thought that this article was some sort of satire, until, with mounting horror, I decide the perpetrators were not only deadly serious, but certifiably insane. Apparently, not only are teachers not able to use any form of physical discipline, they are not supposed to be using any discipline at all! This is the gist of the argument:

I had a similar reaction to the article.

The article said:

Pauline Bishop, a Unitec lecturer with 20 years experience in early childhood education, this week told the Early Intervention Association conference in Auckland that Supernanny techniques were unprofessional for teachers.

“What you’re really doing is you’re punishing the child for doing something that is not appropriate, instead of teaching them, which is our mandate,” Bishop said.

“It could be quite traumatic for children they might have hit somebody because they didn’t understand or they couldn’t communicate so they lashed out.

“Instead of teaching them a way of communicating, we’re punishing them by putting them on a naughty chair and giving them time out.”

MacDoctor continues:

One wonders if “20 years of experience” actually included children, or was this all academic “experience”? This is early childhood education we are talking about – toddlers and preschoolers. These are kids in their formative years, who need to know where the boundaries of good and bad behaviour lie. They are not having problems in”communication”, they are having problems with group dynamics and interactions. If they are not told what is and is not acceptable behavior, they will have to learn this the hard way with damaged relationships, social ineptitude and even criminal activity and prison. It is vital that kids learn boundaries.

Ms. Bishop’s bizarre approach is a direct result of not considering any behaviour right or wrong. Wrong behaviour is “naughty” and requires punishment in a right/wrong model. In Ms. Bishop’s world, undesirable behaviour is not wrong but “miscommunicated”. The child does not require punishment but counseling. Misbehaviour is a learning experience for everyone.

And we see the effects of such thinking in the article I posted yesterday where a 17 year old defends the murderer of Augustine Borrell as being just as much a victim. No clear understanding of right and wrong.

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The fiscal stimulus

February 17th, 2009 at 2:00 pm by David Farrar

MacDoctor has an excellent response to the analysis done on Pundit over the $9 billion fiscal stimulus. Tim Watkin on Pundit says most of the stimulus is “old money” not new.

MacDoctor reponds:

Tim gets understandably offended by the fact that fully half of the fiscal stimulus is new spending already earmarked by Labour, including, amusingly enough, the purchase of Kiwirail.

I should point out that Tim’s problem is due to the fact that he is interpreting the words Fiscal Stimulus in the very socialist fashion used by Rudd, Brown and Obama – all died-in-the-wool Tax-and-Spend socialists. Fiscal Stimulus in this sense of the word means “Invent large sums of money from nowhere, then spend it like there’s no tomorrow”.

Bill’s answer is straight from Treasury – who are about as socialist as Roger Douglas. To them, Fiscal Stimulus means “amount of extra money being put into the economy” – nothing more, nothing less. Labour’s committed spending counts towards a fiscal stimulus just as much as National’s new spending. This is normal accounting practice and is not some strange plot by National to impress the media.

There is a big difference between “spending” and “stimulus”.

Tim’s objection to the inclusion of Labour’s extra spending appears to rest on the groounds that it occurred well before the economic crisis. This is meaningless in terms of the stimulatory effect it will have on the economy. Had it not been for the economic crisis and fact that New Zealand was moving in to a recession, Labour’s spending may well have kept inflation above the 5% mark, so stimulatory was it. The economy does not care where the spending was approved by Labour or National, it will still react to it in definable ways.

Tim also seems to object to the inclusion of spending on schools and roads on the understanding that these were already approved by Labour, but just moved forward. It seems to have escaped him that that is exactly what is required – an increase in current expenditure rather than later spending. Almost certainly, Labour would be doing the same thing, if it was still in power.

Those from the left want “extra” spending because that is what the left believe in – higher taxes and more government spending. But that is not the only way to increase the fiscal stimulus and bringing spending foward is, as MD says, an excelletn way to do that.

We are going to face a horrendous deficit and debt problem for at least a decade. If the Government is playing smart by having a large stimulus, without incurring ongoing expenditure that we have to borrow to pay for, good on it.

Having said all that, there is a fundamental mistaken assumption that Tim and the guys at Tumeke! and the Standard have made. It has also been made by the media and by Messrs. Rudd, Obama and Brown. It is the assumption that it is the amount of money being spent that is important. This is entirely false. It is actually how and where the money is spent that is vital.

Rudd has injected money directly into peoples pockets. This is a very popular move, but one that provides only a very short lived stimulus. Obama has huge swathes of useless “pork” in his package. Brown appears obsessed with owning banks.

Key, on the other hand, is spending frugally and carefully in the places he thinks he will do the most good for the economy in the long run. He has little money to play with (thanks, in large part, to Labour) and is making the best use of it he can. Arguing about the actual size of the stimulus is like arguing about the colour of the bus that is about to run you down.

I can only say I agree,

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Blog Bits

January 4th, 2009 at 2:28 pm by David Farrar
  1. Neil Sanderson has research from Pew. In 2008, the number of people gettign their news off the Internet went from 24% to 40%, beating newspapers at 34% for the first time.  Tv remains top at 70R% but is slowly declining.
  2. Chris Trotter has a repost of a 2001 address he gave on defence. Many may be surprised by his views. I found myself agreeing with much of it!
  3. Tim Blair notes that *only* 1,147 cars were burnt in France on New Year’s Eve, which was described by authorities as “rather calm”
  4. MacDoctor finds the new English requirements for foreign nurses as idiotic at a time of nursing shortages, and points out most NZ nurses could not meet the new standard.
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Blog Bits

December 29th, 2008 at 4:20 pm by David Farrar

Poneke is in Brisbane and has discovered it has the buzz of prosperity:

On the surface, the prosperity can be seen in the world-class infrastructure of roads and electric rail lines that Auckland in particular has not been able to achieve despite decades of talk; the very high standard of housing, commercial buildings and public facilities; the wages that really are stunningly higher than at home; the many job vacancies in the papers even on the Saturday after Boxing Day. Australia has not had a single quarter of negative growth this year while we have had three (though the Aussies fret about it and fear recession might still happen). I could go on.

MacDoctor shares some first hand experience of emergency clinics:

An article in the Weekend Herald (not yet online) entitled “High cost stopping Kiwis visiting the doctor” tells us that over two thirds of New Zealanders over 20 have avoided visiting a doctor because of the cost. I didn’t need any research to tell me this is true, because these people pitch up to emergency departments throughout the country with the line, “I couldn’t afford to go to my GP”  or it’s alternative “I owe my GP too much money”. …

I view these two excuses with a great deal of cynicism. Many who use these lines are drunk or have nicotine stains on their fingers (or both). They drive up in expensive cars and sport MP3 players (many are genuine iPods). They typically arrive not long after the GPs have all closed for the evening, or over the weekend. These are the “milkers of the system”  – They know how to work the health system to their advantage and they use Emergency Departments like a GP clinic. …

I suspect most of the two thirds of New Zealanders who said that they do not go to a doctor because of cost, are really saying that they would rather spend their time and money on something other than their health. It has nothing to to with lack of access and much to do with lack of interest. Until we, as a society, start to see that health is important and worthy of investment, this problem will not go away, regardless of the amount of money governments may throw at it.

Hear hear. I think all bar the very poorest should pay something towards their healthcare.

Bernard Hickey recommends a Kim Hill interview with JJ Joseph – a man who used to beat his wife. It’s a very moving interview that shows people can turn their lives about.

And finally Lynn Prentice at The Standard manages to link Bernie Madoff’s ponzi scheme to National’s planned repeal of the EFA. The hilarious part is:

based on recent experience of their autocratic, arrogant, and undemocratic behavior in the house, we will probably see some opaque, badly written, and badly thought through legislation pushed through under urgency.

What does he call the EFA if not badly written and badly thought through? And he ignores of course that unlike Labour, National has said it will consult all parties over the replacement legislation. It was Labour that tried to use bipartisan electoral law to screw over its enemies.

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Alternate reality alert

December 5th, 2008 at 10:05 am by David Farrar

MacDoctor highlights a visit to an alternate reality by Phil Goff”

There is an old adage that if you are going to lie, then you are more likely to get away with it the more outrageous and barefaced the lie. I’m not sure if that is true, but Phil Goff certainly believes this. On the same day that the “hole” in the ACC accounts mushroomed to a staggering $2.5 billion, Phil “I want to be a real boy” Goff made this statement:

Labour leader Phil Goff said Treasury’s briefing highlighted that National had inherited a healthy set of books and it should not be squandered.

I’m impressed, Phil. Machiavelli himself couldn’t have told such a whopper. I particularly enjoyed the suggestion that National might squander the money that you have so carefully built up. Very ballsy of you, I must say.

Unfortunately, I think you might find that that nice Mr Key is just lacing up his hobnail boots…

Can someone let me know in what dimension the following is considered a healthy set of books:

  • A decade of deficits projected
  • Debt to increase by over $30 billion from 20% of GDP to 30% of GDP
  • Inflation at 5%
  • Unemployment projected to hit 6%
  • A recession
  • Billions of dollars needed to bailout ACC

At the first question time, some Govt backbenchers should ask questions to Mr English on whether he agrees Mr Goff has left him “a healthy set of books”.

UPDATE: The crown accounts out today show the Government’s surplus has plunged by $5 billion from a $1.5 surplus to a $3.5 billion deficit. More of Phil’s healthy set of books! The plunge is primarily due to unrealised losses on investments, but they will have flow on effects to income and lead to increased debt.

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Ideology kills

November 5th, 2008 at 11:36 am by David Farrar

MacDoctor blogs on how Labour is placing ideology above patient care. He explains:

There is excess capacity in the private health system. There is also an ability in the private health system to provide even more excess capacity at relatively short notice. Most surgical clinics have been constructed to allow rapid expansion of wards and theatres, particularly if resource consents are streamlined.

There are thousands of people on elective surgical waiting lists who are waiting many months to years for operations. Most of them could have already had their operations if the private sector was allowed to properly partner with DHBs. Currently, most private sector “public” operations are done under limited contract – often 1 or 2 surgical sessions at a time. There is absolutely no incentive for the private hospital system to “flex up” as the huge demand is being dealt with in a piecemeal fashion.

This is bad enough for Mrs. Smith who has waited three years for her hip operation and can barely walk. It is life-threatening to those who need cardiac surgery or radiotherapy. I am certain that, if Saturday sees the return of a Labour government, the brand new radiotherapy clinic in Auckland will have a few patients sent to it by the DHBs – the ones who have waited well beyond a safe waiting time. There will, however, be no concerted plan negotiated between the DHBs and the new clinic to maximise this new resource, because Mr. Cunliffe is apparently nearly out of his comfort zone.

This means, to put it baldly, people will die because of his ideology.

He also dispels the myths around using the private sector more:

I hear objections to using private health care occasionally from my colleagues. Their objection is that, if you move these patients out of the public system, hospital doctors will eventually have insufficient variety of work to maintain their skill sets (”I’m in charge” Cunliffe puts it as “sucking capacity out of the public system – a nonsense phrase, if I have ever heard one). Apart from the dubious ethics of essentially denying people timely care in order to maintain a doctor’s skills (or non-existent theoretical hospital capacity), this objection does not hold water. Most of the surgery dealt with by the private clinics is low complexity. Private clinics usually lack ICU beds and so cannot deal with the very complex. What maintains your skills better – 10 routine hip replacements or three complex revisions? Removing a dozen easy appendixes or a couple of complex appendix masses?

He concludes:

So let’s stop this whining about privatising medicine and use all of our resources, both private and public, to get the medical care that people need. National’s thoughts on this are very promising, particularly the multiyear funding guarantee which will enable both public and private resources to expand capacity with confidence. Yet another reason to vote for the three-headed hydra. :-)

I note that the Herald uses the word “Elite” meaning “private”. I realise this is probably due to space constraints in their headline, but it is hugely insulting to those people who are having to mortgage or sell their homes in order to get the surgery they desperately need. I think we need to get past the place where we see private medicine as the domain of the wealthy and see it as a normal and valuable part of the entire health system.

This should be an op ed in a newspaper.

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An alternative billboard

September 25th, 2008 at 3:00 pm by David Farrar

MacDoctor proposes an alternative billboard for National

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Sickness Benefit

August 12th, 2008 at 3:12 pm by David Farrar

MacDoctor has an interesting post on sickness benefits. He observes:

It is my experience when I do GP locums, that sickness beneficiaries fall into the same categories. There are genuinely ill people, many of whom will eventually gravitate to invalid benefits. There are genuinely sore people who have long-term recovery problems from old injuries. But about a quarter of beneficiaries are undoubtably “swinging the lead”. They are the lower back pains that flounce into your office and flop into a chair without a single grimace. They are the asthmatics who apparently can go to gym or karate, but wheeze whenever they are near work. They are the depressives who laugh and joke with you as you fill in their form.

The 25% estimate would equate to around 10,000 people.

Now people might ask why doctors give out certificates. MacDoctor explains in full, but the summary is:

The real reason that all GPs blithely sign sickness benefit forms, even though we know they may not be genuine, is that we don’t know that they are not genuine, we only suspect. For most of the suspicious cases, you would need a number of investigations, or a specialist opinion to confirm your suspicion. Your patient will either refuse to go, or make appointments with the specialist and then simply not attend. And there is no way you can force them.

His solution:

The only way this can stop is if you compel sickness beneficiaries to have an annual (or six monthly) medical with an independent doctor, preferably a specialist. This is not only good politics, it is actually good medicine, as specialist review of long-term illness is good clinical practice. Frankly, I don’t see this as being unpopular with sickness beneficiaries, apart from the ones milking the system. The majority of them would love to get better and go back to work, if they could.

National’s policy is that after 12 months on teh sickness benefit you see a designated independent doctor.

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