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@ -13,9 +13,9 @@ I recently had to deal with something no parent enjoys. My child injured her kne
The three systems in question are private and public health, the ATO and superannuation, and the Child Care Subsidy and Human Services. We recently attempted to take the matter through the Administrative Review Tribunal, but the invasive and costly structure put in place for that review means only one thing in practice. We have to let the system win because of its pervasive nature and internal culture of wearing the public down until they do not have the energy to fight any more. I will touch on the tribunal in passing, but this post is not about the tribunal process. The three systems in question are private and public health, the ATO and superannuation, and the Child Care Subsidy and Human Services. We recently attempted to take the matter through the Administrative Review Tribunal, but the invasive and costly structure put in place for that review means only one thing in practice. We have to let the system win because of its pervasive nature and internal culture of wearing the public down until they do not have the energy to fight any more. I will touch on the tribunal in passing, but this post is not about the tribunal process.
This blog post is accompanied by emails to the respective Ministers, my local representative, and reach outs to news outlets. It is the last attempt to have someone actually listen, rather than send canned emails that treat me like a child who did not do any prior research. Yes, Jacqualine Myint, I am referring to the response to my previous enquiry which completely missed the point that I had already outlined how the systems were interacting. This blog post is accompanied by emails to the respective Ministers and my local representative. It is the last attempt to have someone actually listen, rather than send canned emails that treat me like a child who did not do any prior research. Yes, Jacqualine Myint, I am referring to the response to my previous enquiry which completely missed the point that I had already outlined how the systems were interacting.
I would like to note that Ali France, my local MP, has reached out to me to ask for my story to assist with her work in the House of Representatives Standing Committee on Health, Aged Care and Disability on improving access to specialty doctors. If that committee work is something that matters to you, they are accepting submissions at the Department of Health and Aged Care consultation page on specialist affordability and access. You can see it [here.](https://www.health.gov.au/our-work/consultation-on-specialist-affordability-and-access?language=en) I would like to note that Ali France, my local MP, has reached out to me to ask for my story to assist with her work in the House of Representatives Standing Committee on Health, Aged Care and Disability on improving access to specialty doctors. If that committee work is something that matters to you, they are accepting submissions at the Department of Health and Aged Care consultation page on specialist affordability and access. You can see it [here.](https://www.health.gov.au/our-work/consultation-on-specialist-affordability-and-access?language=en). It's a step in the right direction to at least shining light on the problem but I won't hold my breath for any concrete outcomes.
To work through this, I am going to put together a timeline. I have also uploaded copies of the relevant correspondence so that you can read just how condescending our bureaucracy can be. This post has three sections. The first covers the timeline of the initial event and the health care received. The second covers the timeline of the tax event and its fallout. The third is an analysis of how the three systems interact to create a terrible outcome. To work through this, I am going to put together a timeline. I have also uploaded copies of the relevant correspondence so that you can read just how condescending our bureaucracy can be. This post has three sections. The first covers the timeline of the initial event and the health care received. The second covers the timeline of the tax event and its fallout. The third is an analysis of how the three systems interact to create a terrible outcome.
@ -77,19 +77,19 @@ It is clear from the timeline that the compassionate release of superannuation i
### The Letters ### The Letters
Read together, the three letters in the appendix paint a clear picture. The Treasurer's office confirms the design of the system. Early release is taxable, it counts as income for income tested payments, and the Government has no current plans to change that. The Health Minister's office confirms that gap cover is voluntary, that informed financial consent is the main consumer protection mechanism, and that the Government's principal response is an upgrade to a website. The local member's office acknowledges the problem, points to a committee inquiry, and stops there. Read together, the three letters in the appendix paint a clear picture. The Treasurer's office confirms the design of the system. Early release is taxable, it counts as income for income tested payments, and the Government has no current plans to change that. The Health Minister's office confirms that gap cover is voluntary, that informed financial consent is the main consumer protection mechanism, and that the Government's principal response is an upgrade to a website. The local member's office acknowledges the problem, points to a committee inquiry, and stops there, at the very least they admit it needs fixing and are trying to work through it.
Not one of those letters engages with the central point of my correspondence, which is that the three systems interact in a way that punishes the behaviour the policy is supposed to encourage. The policy says: if you cannot afford essential medical treatment, you can access your superannuation. The tax system says: that access is taxable income. The Human Services system says: that taxable income will now reduce your Child Care Subsidy. The health system says: that is not our problem, talk to the insurer. The insurer says: that is not our problem, the doctor did not use gap cover. The doctor says: that is not our problem, gap cover does not cover our costs. So nothing is anyone's problem, and the family pays the difference. Not one of those letters engages with the central point of my correspondence, which is that the three systems interact in a way that punishes the behaviour the policy is supposed to encourage. The policy says: if you cannot afford essential medical treatment, you can access your superannuation. The tax system says: that access is taxable income. The Human Services system says: that taxable income will now reduce your Child Care Subsidy. The health system says: that is not our problem, talk to the insurer. The insurer says: that is not our problem, the doctor did not use gap cover. The doctor says: that is not our problem, gap cover does not cover our costs. So nothing is anyone's problem, and the family pays the difference.
To the Minister for Social Services, the lack of communication from your office is telling. To the Health Minister's office, why would you send me a response that simply repackages research I have already done and then wash your hands of the matter? To the Treasurer's office, you need to get someone with genuine training in how these systems interact to write your letters, because the response I received defended a design choice without ever addressing the interaction effect that I had specifically written to raise. To the Minister for Social Services, the lack of communication from your office is telling. To the Health Minister's office, why would you send me a response that simply repackages research I have already done and then wash your hands of the matter? To the Treasurer's office, you need to get someone with genuine training in how these systems interact to write your letters, because the response I received defended a design choice without ever addressing the interaction effect that I had specifically written to raise.
### A note on the broader context ### Some broader observations
It is worth saying, for the avoidance of doubt, that none of the people I dealt with in the public service were individually unreasonable. The surgeon was excellent. The accountant was helpful. The staff in the various call centres were polite. The problem is structural, not personal. The system is built in a way that produces this outcome, and the only way to change the outcome is to change the system. It is worth saying, for the avoidance of doubt, that none of the people I dealt with in the public service were individually unreasonable. The surgeon was excellent. The accountant was helpful. The staff in the various call centres were polite. The problem is structural, not personal. The system is built in a way that produces this outcome, and the only way to change the outcome is to change the system.
There is also a wider question here about the cost of making private care the only timely option. The official wait time we were quoted was twelve to twenty four months for the initial specialist appointment alone, before any surgery. In a young person, that delay is not neutral. It changes the kind of injury from a recoverable one to a chronic one, it lengthens the period of disability, it reduces the chance of return to sport, and it increases the lifetime cost of treatment. If the policy design of the compassionate release system is meant to relieve pressure on the public system by allowing families to go private, then the policy design of the tax and welfare systems is undermining that intent in the year that follows. There is also a wider question here about the cost of making private care the only timely option. The official wait time we were quoted was twelve to twenty four months for the initial specialist appointment alone, before any surgery. In a young person, that delay is not neutral. It changes the kind of injury from a recoverable one to a chronic one, it lengthens the period of disability, it reduces the chance of return to sport, and it increases the lifetime cost of treatment. If the policy design of the compassionate release system is meant to relieve pressure on the public system by allowing families to go private, then the policy design of the tax and welfare systems is undermining that intent in the year that follows.
In the end, I should have just gotten a personal loan. It would have cost me less than the tax and lost benefits combined. In the end, I should have just gotten a personal loan. It would have cost me less than the tax and lost benefits combined. It is incredibally disappointing that this is the case in "World class Public Healther System"
### Where this leaves us ### Where this leaves us
@ -97,7 +97,6 @@ I do not expect the system to respond quickly. I do not expect the letters I hav
If you have had a similar experience, the consultation on specialist affordability and access is open for submissions, and the Standing Committee on Health, Aged Care and Disability is accepting input. You can add your submission [here.](https://www.health.gov.au/our-work/consultation-on-specialist-affordability-and-access?language=en) If you are a policy analyst inside government, and you have read this far, then the question to take back to your work place is simple. Does any part of your work consider the interaction effects of early release, tax and income tested payments, or does each part only consider its own patch? If the answer is the latter, then this post is for you, and so is the next family that comes through the door. If you have had a similar experience, the consultation on specialist affordability and access is open for submissions, and the Standing Committee on Health, Aged Care and Disability is accepting input. You can add your submission [here.](https://www.health.gov.au/our-work/consultation-on-specialist-affordability-and-access?language=en) If you are a policy analyst inside government, and you have read this far, then the question to take back to your work place is simple. Does any part of your work consider the interaction effects of early release, tax and income tested payments, or does each part only consider its own patch? If the answer is the latter, then this post is for you, and so is the next family that comes through the door.
## Appendix: The correspondence ## Appendix: The correspondence
What follows are the substantive letters exchanged with the relevant offices. I have reproduced them so that the reader can see exactly what was said, in the same form that it was said, and judge for themselves how seriously the substance of my concerns was engaged with. What follows are the substantive letters exchanged with the relevant offices. I have reproduced them so that the reader can see exactly what was said, in the same form that it was said, and judge for themselves how seriously the substance of my concerns was engaged with.