Fitness and Health | Slack Investor

General Practitioners (GP’s) in Australia … and April 2023 – End of Month Update

Slack Investor is a great believer in writing about experience and a few (fortunately) minor health matters has had him recently exploring Australia’s health system. In Australia, the General Practitioner (GP) is usually the first port of call if you have a health problem and of Medicare will fund a portion of your costs for a consultation. Your relationship with your GP is an important one and it is vital that you feel comfortable with your GP’s manner, knowledge and skills. There are two tiers of GP pricing in Australia.

Bulk Billed – where there is no extra consumer payment required if you have a valid Medicare card.
Mixed Billing – where patients will pay a a bit extra in addition to the Medicare allowance

Bulk billing doctors are becoming harder to find as the rate of bulk billing has fallen to its lowest level in 13 years . According to government figures, it was 80.5% in the 2022 December quarter. Though this figures is likely to be “grossly inflated” as many practices have charged a separate eftpos transaction at the desk and this does not appear in Medicare figures.

What should happen is that either the patient is bulk-billed and pays no money – or they are charged a private fee, a portion of which is rebated by Medicare directly into the patient’s bank account.
Dr Margaret Faux, Health Insurance Law Academic

Levels of bulk-billing are probably closer to 40% as shown in the recent survey by The Age. In answer to the question “Does your GP Bulk-bill or charge you a gap fee?”

Survey results from the Resolve Political Monitor conducted by The Age

This Age poll is in line with results by an excellent organisation called Cleanbill that are driven by a mantra that Slack Investor wholly agrees with …

” … healthcare is at its most accessible when you can see all of your options and their costs before you’ve made a booking.”
The mission statement for Cleanbill

The Cleanbill site is easy to use for locating GP’s in your area and transparently gives their total fees for a standard, or a long consultation. Once you have narrowed your search, you can usually make a booking straight from the site.

Only 42.7% of GP clinics serving nearly 18 million Australians
bulk bill (charge no out-of-pocket fee to) all patients.

At the 57.3% of GP clinics that charge an out-of-pocket fee the average extra cost for a standard, 15-minute consultation is $40.25 (out of a total cost of $80).
Australia-wide survey by Cleanbill – January 2023

The decline in bulk billing is not the GP’s fault as practice costs have continued to rise and the Medicare rebate has not kept pace with the rise in these costs. In 2013, the rebate was frozen for 6 years – and, even last year, though inflation was 6.1%, the Medicare rebate was only increased by 1.6%. The chart below shows how the rebate has failed to keep pace with inflation (CPI) and average weekly earnings (AWE).

The Medicare GP rebate has failed to keep pace with inflation (CPI) and average weekly earnings (AWE) – From ochrehealth.com.au

… more than half of GP practices (55%) plan to reduce bulk-billing and increase gap fees this year
2023 GP Insights Report

Are we heading down the track to a US – style system?

Slack Investor has lived in the US – and hopes not! … and, is pleased that the new Australian government is putting a bit of thought and money into this problem with an announced $2.2b injection of funds into Medicare – no detail yet.

Now Slack Investor does not want a completely “free ride” as he realises that healthcare must be paid for. Even in the much admired Scandinavian health systems there is usually a co-payment associated with a visit to a doctor of $20-25 AUD.

In Australia, many patients pay hundreds of dollars for non-GP specialist consultations, and $40–$50 out of pocket for GPs.
Dr Jillian Farmer – Insight Plus

So perhaps it is just a matter of nudging the co-payment down a bit by increasing the Medicare rebate, and some other reforms – all will be revealed on the Australian government budget night – 9 May 2023.

Slack Investor is hoping for some progress as the Australian Healthcare system is generally good … but could be better. In the meantime, if you are looking for a GP, use Cleanbill to help you find one.

April 2023 – End of Month Update

Slack Investor remains IN for Australian index shares, the US Index S&P 500 and the FTSE 100. It was a positive month for the Slack Investor followed markets. The ASX 200 up 1.8%, the S&P 500 up 1.5%, and the FTSE 100 powering on, and up 3.1% for the month.

All Index pages and charts have been updated to reflect the monthly changes – (ASX Index, UK Index, US Index).

Live Long and Prosper … Not in the US

Spock from Star Trek with the Vulcan Salute … “Live Long and Prosper” – Paramount +

The Vulcan salutation that Spock would give his fellow Vulcans is a catchphrase of the Star Trek series and a reminder that “living long” in a state of good health, would be a nice thing to achieve.

Slack Investor has been thinking about health lately and his research tells him that good health outcomes are not always just a matter of spending more money. The US is a good demonstration of this point. In an analysis of health data for the 38 OECD countries, though spending nearly twice as much as the average OECD country on health care, the US has the highest rate of people with multiple chronic health conditions.

2021 per capita health expenditure (spending: government + private programs + out of pocket expenses) for OECD Countries – From CNN Health

Money and Healthcare – What’s gone wrong in the US?

“16% of all officially recorded COVID-19 deaths (worldwide) occurred in the US, despite having only 4% of the world’s population”
The Commonwealth Fund

In most countries, using the broad indicator of life expectancy, as health expenditure increases, so does life expectancy. However, the US is an outlier. The populations of countries with much lower health spending than the US enjoy considerably longer lives and better health outcomes with other measures. The interactive chart from ourworldindata.org demonstrates this.

” … the U.S. is the only country we studied that does not have universal health coverage, but its health system can seem designed to discourage people from using services,”
The Commonwealth Fund

Universal Health Coverage (UHC) is defined as everyone having access to good quality health services without suffering financial hardship but this is a complex area and each country does it differently. UHC is usually funded by taxes or access to insurance schemes.

There are many reasons for this disparity with the US and other countries. The American Public Health Association say that improvements could be made by improving access to a UHC system, increasing primary care prevention, and more money spent on social services to support their citizens, rather than “sick care”.

The US has two streams of healthcare, those with insurance (usually tied to employment) and those without. In 2021, 70 million Americans are either not insured, or underinsured. Those without insurance usually get a much poorer health service and yet, in the other stream, the top 5% of spenders are incredibly well serviced and account for almost half of the health spending.

There are lessons to be learned here for all governments – it might mean an increase in taxation, but I would rather have the top ranked Norwegian style of healthcare rather than a US style.

Dying is expensive

Medical spending in the last twelve months of life accounted for approximately 8–11 percent of aggregate medical spending in most countries
2009-2011 Health Affairs study – using data sets from 9 OECD countries

As we get older, we get more expensive to run – more things going wrong! There are high costs associated with dying, as this is often in association with hospital care.

Overall, the average annual health service cost per person for people in their last year of life was 14 times as high as for those not in the last year of life ($24,000 and $1,700 respectively).
Australian Institute of Health and Welfare

It seems that it is not just our last year that is expensive to the health system, One 1993 U.S. study found that 30 to 40 per cent of costs incurred in the last year of life were incurred in the last month of life! Slack Investor calculates this as meaning 3-4% of lifetime aggregate medical spending is spent in our last month!

Cripes … Slack Investor is worried that he might turn up to hospital and some bureaucrat with a clipboard (or AI Bot!) will tell me that they have crunched the numbers …. and it’s just not worth it to admit me.

This deep dive into healthcare has made me determined to take a bit of control. I will try to stay as healthy as possible for as long as possible … better stop here and go for a jog – and have a healthy meal tonight!

Golden Triangle of Happiness … and December 2020 – End of Month Update

After just going through a Christmas period where, in these COVID-19 times, I was lucky enough to spend time with some family – I was struck with an unusual contentment. It is easy to get bogged down with the day to day challenges of life, but Slack Investor occasionally gets self reflective and has long realised that he is a happy bloke. This state is much sought after and it often doesn’t naturally happen. A recent publication that has lodged in my tiny brain is the Australian Wellbeing Index. This research has been conducted twice a year over the last 15 years and involves more than 60,000 participants.

Personal wellbeing appears to increase with age, with some of the happiest Australians aged 65 and over.
Australian Wellbeing Index – 2019 Joint Research between Deakin University and Australian Unity.

The latest instalment of one of Australia’s largest wellbeing surveys has found that, besides genetics, there are three simple indicators of a happy life. Financial security, a sense of purpose in life, and good personal relationships make up the “golden triangle” of happiness. The full report can be found here.

well-being2 — Source: thenewdaily.com.au

Financial Security

This is really what this blog posts mostly about – so I wont expand too much here. But if you feel that you are in control of your money then you can avoid many of the financial stresses. While having money does not make you happy, if you don’t have any, it can make you miserable. Not surprisingly, the survey found that the feeling of wellbeing gradually rises for household earnings up to about $100,000 a year. Surprisingly, earnings over this point found the relationship between happiness and wealth drops off dramatically.

Relationships

… the people who fared the best were the people who leaned into relationships, with family, with friends, with community,”
Dr. Robert Waldinger , Harvard University

We are humans and (mostly) social creatures – a sharing of your life and having someone who cares about you makes you feel better about yourself. A Harvard study that has been going for 80 years found that people who are more socially connected to family, friends, or community are “happier, they’re physically healthier and they live longer than people who are less well connected,”

“It doesn’t need to be a sexual relationship, but it needs to be an emotionally intimate relationship where you can share troubles and sorrows and joys,”
Prof Bob Cummins, Deakin University

Sense of Purpose

Something to do … your get up in the morning and you have a project, part time job, volunteering, exercise, a hobby – but it is something! People are happier when they are active.

But, beyond the “golden triangle” of happiness, there are other approaches – Rather than take on each corner of the triangle, just try to just make little micro changes to your life – Perhaps a little more exercise, or contact an old friend …

An older friend once pointed out to me that we were lucky enough to have choices with our lives. He stressed our limited life span and suggested I make a list of the things that I really liked doing – and then try to engineer my life to maximise these good things and then minimise the other, less enjoyable. but necessary stuff. When you collect all the moments that make you happy … you might just … be happy!

Spend more time with people you like, get outdoors a bit more, listen to some music, have some new experiences, help other people …
“Happiness thinker” Professor Paul Dolan

December 2020 – End of Month Update

Slack Investor remains IN for Australian index shares, the US Index S&P 500 and the FTSE 100. All Slack Investor followed overseas markets this month had rises (ASX 200 +1.1%; FTSE 100 +3.1%; S&P 500 +3.7%).

I still remain nervous about the US market with its high valuations. The closing value of the S&P 500 (3756) is now 18% above the current stop loss at 3200. If the margin gets to 20% (UPR LIMIT 3840)), then I will find a place to move my stop loss upward. In these uncertain times, I will monitor my index funds weekly and if, at the end of the week my Index funds are below the stop loss, then I will put a post on the blog and sell at the next opportunity. All Stop Losses are Live.

S&P 500 Monthly chart December31 2020- From incrediblecharts.com

All Index pages and charts have been updated to reflect the monthly changes – (ASX Index, UK Index, US Index). The quarterly updates to the Slack Portfolio have also been completed.

Exercise and Wine … What could go wrong?

Dr Spock with the Vulcan Salute which usually comes with the salutation “Live long and Prosper” – Image may be subject to copyright – Star Trek

Most of Slack Investor’s blog is about becoming financially sound, but there is also a need to be happy and healthy and to flourish in other areas. Spock and his fellow Vulcans are all over this idea – Live Long and Prosper – What is the use of becoming financially prosperous if you can’t be around to enjoy the choices that this state can offer.

One of my favourite UK blogs The Escape Artist also flogs the theme of trying to be fit and healthy of body … as well as looking after your financial state. There can be a parallel in approaches to athletic and financial matters.

Set Goals

36 years ago, my brother and I were sitting in a Greek Restaurant with a bottle or two of Retsina and we were full of youthful optimism and set ourselves a list of things we would like to get done in life. They were exciting things like “have a girlfriend”, jump out of a plane, learn how to scuba dive, go on a TV talent show, etc. I am pleased to say that most goals were achieved within 5-years of that goal setting night – but the elusive one was to “Run a marathon”. We found this task even harder than finding a girlfriend! 42 kilometres is a long way and the training required to do this thing properly had this feat rolling around in the “too hard basket” for decades.

That was … until 2018.

Work Hard through efficient research

Slack Investor believes that there can be many solutions to a problem, and as my body aged and I became even slacker, it was apparent that the conventional route of working up to this great distance over time and training 6-days a week was not going to cut it. One look at the Runners World suggested marathon training program over at least 6 months and starting at 24 km per week building up to 64 km – gave me the “vapours”. The “Fair Dinkum” marathon runners train hard and aim for below 4-hr times and these folks have my greatest respect. Most marathons have qualifying times for participants and they usually sweep the slower runners off the course if they can’t complete in 6 hours. My challenge was to find a marathon in the world that had a generous cut off time – that would accommodate slack athletes.

While not a complete fitness numpty, Slack Investor has trouble running 5km comfortably at a shuffling pace – and the thought of running further than that is mildly appalling! You can see the dilemma here.

Festivals of “Convivialité ” to the rescue

Luckily we have the French to remind us of the joy of life and each year they have 20 Conviviality challenges that are run by regional communites that involve some sort of running combined with tastings of wines and other regional delicacies. To add to the festival theme, the runs are usually done in fancy dress.

The most famous of these Convivialite’s is the Marathon du Medoc where, one day in September, 8500 participants run around the beautiful Medoc area, near Bordeaux. Registrations must be done by the previous March and I found the combined accommodation/run packages the easiest way in. There are refreshment stops along the way where 20 of the wineries around the Pauillac area will offer water, wine, music and food. It is tempting to linger at each Chateau but there is the ever present sweeping crew that will put you out of the marathon if you are slower than the required 6.5 – 7 hr pace.

In the same way as investing, Slack Investor likes to break things down into achievable chunks. I was working on a theoretical finishing time of 6 hrs and 45 min (405 minutes).

First 30 km Plan – I thought that using my ungainly shuffling jog I could do 5 sets of 5km runs at a 7 min per km pace (175 min). I could walk a kilometer between each 5km runs (to gather breath!), 4 lots of walking at a 10 min per km pace (40 min) . This plan will use up a total of 215 minutes to do 30 km.

Last 12km Plan – I knew that I would be knackered here … but still hoping I could comfortable walk a kilometre in 10 min. If I walked the last 12 km, that would use up 120 min.

The planned running/walking would use up 335 min (215 +120), leaving 70 min (405 – 335) for wine tastings, toilet stops, recoveries! Even allowing for time shrinkage – this was a good plan!

Image may contain: David Nahrung, smiling, standing and outdoor — Slack Investor in a fetching outfit prior to the the run with fellow Aussie “Steve Irwin”

Image may contain: 1 person, smiling, outdoor — Slack Investor about to cross the finish line – Goal achieved!

Well, I signed up for the Medoc 2018 Marathon … and happily, the plan was executed (in a fashion). There was more time shrinkage than anticipated – and it was hot! I did not have a wine at every stop (Although my colleague “Steve Irwin” did! I was scared the wheels would fall off my plan if I imbibed too early …. so I had a wine-free first 20 km … but after that, I found each of the Chateau offerings delightful.

Would I do this again? It was a lot of fun and a worthy bucket list destination – but it was hard! The day after there was a 10km walk through four Chateaus over 3 hours. Much more my style, I will seek out these more leisurely, but still challenging, events in future. I have now retired from marathon running and look forward to new adventures.

Choose your battles … then Go Hard. Live Long and Prosper … in wine is truth!