On The Trump Shooting And A Potential Hike In Fees For Visiting The Doctor

Having watched Donald Trump systematically exploit social grievances, urge people not to accept his election loss and incite his followers to violent insurrection... it is a bit hard to swallow the media descriptions over the past 24 hours of Trump being a “victim” of violence. More like a case of chickens coming home to roost.

The sense of karma goes way back decades… Yesterday in Pennsylvania, Trump finally came under fire, 60 years after he had repeatedly dodged the Vietnam war draft. On four occasions, Trump won a deference so that he could finish a college degree, and the fifth time was because Trump suddenly discovered he had “bone spurs” on his feet. All up, Trump’s “bad feet” excuse serves as a useful reminder that while it is the wealthy elites who start America’s wars, it is not their sons and daughters who commonly fight and die in them.

Footnote One: Interesting take last night by INews reporter Logan Church:

I've spent a lot of time in recent months talking to political commentators, politicians, analysts — you name it — and almost all of them have said the same thing: the United States is on the brink of political violence. Well, we're here now. It's happened.

Hmm. Apparently, the INews correspondent and his sources never heard of the Capitol riot on January 6, 2021. After Trump urged his followers to “fight,” five people died: a Police officer was beaten to death, a rioter was shot and three other people died during the rampage. To take one of many other examples... at a neo-Nazi rally in Charlottesville in 2017, MAGA fascists killed an anti-racist protester. Trump’s response? He claimed there were “some very fine people on both sides” that day. Trump is not a victim. Yesterday, he narrowly avoided being consumed by the fires that he has lit, and fanned into flame.

Footnote Two: In line with the theme that violence is far more newsworthy if it involves a celebrity… on the same day the media went apeshit because Donald Trump had been nicked on the ear, 91 Palestinians were killed in an Israeli air strike as they sheltered in a refugee camp in southern Gaza.

Rising fees for GP visits?

Dateline: May 2023, and Brooke Van Velden and David Seymour made a meal out of a photo opportunity. The ACT leaders stood in front of a medical centre in St. Heliers and solemnly pledged that if elected, they would boost the “capitation” funds that support GP practices, by as much as 13% overall. “It's about respect and dignity,” the pair chirped, and about putting those virtues back at the centre of primary care.

Right. But flash forward to July 2024, and that promise has evaporated. The coalition government is (a) offering only a 4% increase in capitation funds for GP practices while otherwise (b) giving GPs the green light to raise (by nearly 8%!) the fees that patients have to pay to visit their GP. Incredible. The government is proposing to subsidise GP practices by less than the inflation rate for the past year, and at less than one third of the rate that ACT campaigned on, and it is planning to do so by ensuring that sick people have to pay substantially more to visit the doctor. So much for those crocodile tears about the cost of living crisis.

To restate the obvious: many New Zealanders are finding the current fee for GP consultations unaffordable, and are ending up in hospital emergency departments after their conditions reach crisis point. People are also having to cut back on the medication for themselves and their children, as they struggle to pay the recently re-instituted $5 per item prescription charge per item, down at the pharmacy. Unless the government radically changes tack, we could all soon be looking down the barrel of a $60 fee to visit the doctor.

Imposing a stiff user pays regime on the health needs of low income people is not only morally wrong, but false economics to boot. As the Stuff article points out:

The average cost of an ED visit that doesn’t lead to admittance was $595 in 2019, for example, when it costs the Government $76.95 if a patient spends 20 to 40 minutes with a GP...while overworked GPs sometimes over-refer to the secondary sector because they haven’t got the time to deal with something themselves.

Predictably, the coalition government is saying that it now can’t afford to do better by GPs and their patients. Just as predictably, it is blaming the Labour government for this sudden need for austerity. Somehow though, the same politicians can afford to revive a $3 billion tax break for landlords. Meaning: it is never a necessity, but always a conscious choice as to where the harms caused by austerity measures are allowed to fall.

The Sapere Report

On the campaign trail last year, the centre-right parties pledged to resolve the GP funding crisis along the lines recommended by the Sapere Report of 2022. Among other things, the Sapere report noted that general practice in New Zealand was operating at an annual loss of some $137 million nationally, overall. Plainly, a lot of catch up funding is required to save our system of primary health care from collapse:

For very high need practices, increasing the goal level of servicing to the higher levels we have modelled, sees an increase in capitation revenue of between 34% to 231%, For most practices....the median modelled increase is between 10% and 20% of current capitation revenue.

So… not a 4% increase. An increase of between 34% and 231% is required in high need areas, and 10-20% in the median GP practice :

Overall, funding for general practice care is problematic for a number of reasons, but the core issue is that funding does not align with patient need. This means that services that have a higher than average proportion of people with high health need are not funded adequately to deliver care to their patients. This is a serious deficiency in a core part of New Zealand’s health system.

So we have a serious deficiency in GP funding, but an unserious response from Dr. Shane Reti. This excellent Stuff article provides chapter and verse of a national picture of overloaded GP practices– with postal code variations in GPs fees, GP -to-patient ratios that are embarrassingly worse in New Zealand than in Australia and Canada, amid an unsurprisingly sharp reduction in the ratio of doctors choosing to go into GP work at all.

As Stuff also notes, the data in these tables is from 2018. So, if anything, the current situation is considerably worse. The average charge per GP visits by region for instance, looks out of date. In metropolitan areas, $50 fees or less per visit are (anecdotally) the exception, and not the norm.

Finally, the comments made about the government’s capitation offer in this article in NZ Doctor make for sobering reading:

Hauora Taiwhenua Rural Health Network chief executive Grant Davidson describes the “underwhelming” offer as a “cost-shifting exercise to the general public who are already in a cost-of-living crisis”.General Practice Owners Association deputy chair Stephanie Taylor agrees, saying the “Government basically [is] going to shift the cost of providing that GP care onto the patients, which none of us supports.”

Likewise, General Practice NZ chair and specialist GP Bryan Betty says the expectation that patient fee increases will compensate for the “absolutely inadequate” funding will mean patients “bear the brunt again.”

For many households, the fee rises being proposed would wipe out any financial gains from National’s tax cuts:

For many, Nelson specialist GP Graham Loveridge says that any tax benefit under Budget 2024 could be “neutralised” by potentially higher GP fees and prescription charges.

Footnote: At this point, the 4% offer could be a government feint to see how much of the running costs of medical centres will continue to be borne by GPs, how much will be reluctantly passed on in charges to patients, and how much political backlash there will be (if any) to what the government is proposing.

That would be typical. This government seem to have no interest in finding out the net social cost of its policies. Its approach to public policy appears to be solely transactional, based on the win/loss calculations of the impacts on its own political fortunes.

American politics in song

One precedent for Donald Trump in American politics was Huey “The Kingfish” Long, the left wing lawyer and governor of Louisiana. Long became the hero and champion of poor Americans suffering during the Great Depression. A hero to many, Long was denounced by the Establishment as a demagogue. To Long, Roosevelt’s New Deal was insufficiently radical:

Long was instrumental in securing Roosevelt's 1932 nomination but split with him in 1933, becoming a prominent critic of his New Deal. As an alternative, he proposed the Share Our Wealth plan in 1934. To stimulate the economy, he advocated massive federal spending, a wealth tax, and wealth redistribution. These proposals drew widespread support, with millions joining local Share Our Wealth

Poised for a 1936 presidential bid, Long was assassinated by Carl Weiss inside the Louisiana State Capitol in 1935.

Here’s a brief clip containing the first verse of a song that Long wrote to express his political philosophy.

In the Depression era of the1930s, US politicians would often forge bonds with the crowd via a mixture of musical good times and political speeches. During the late 1930s/early 1940s, the western swing musician W. Lee “Pappy” O’Daniel became the governor of Texas. Later, Johnny Cash even recorded a song about O’Daniel. O’Daniel’s signature tune on the campaign trail was “ Pass The Biscuits, Pappy” but his version of “Dirty Hangover Blues” is also pretty impressive:

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