You don’t need an appointment for a good idea
One Hundred years ago, the German-Italian sociologist, Robert Michels outlined his ``iron law of oligarchy’’ arguing that there inevitably develops a gap between the interests of the represented and the smaller group doing the representing.
Leaders, especially when elections are approaching, start to act in ways that will maximise their chances of holding on to power. Certainly, that’s the way their actions tend to be viewed.
Political opponents and powerful minorities use this ``gap’’ as fertile ground for undermining public confidence if they perceive an advantage from doing so. And this becomes a vicious cycle in turn feeding a wider cynicism
Everything politicians do ends up being viewed through the same jaundiced lens. This is something of a pity really.
On Thursday, I received a remarkable phone call that suggested a development this week deserved a less cynical eye. It came from Ken Cole. I had never met him but I remembered who he was - a larger than life head-coach of the all-conquering Adelaide 36ers Basketball team in the 1980s. Part master-tactician, part basketball evangelist, Cole had been a charismatic figure in a sport that, at the time, was on the up and up. Tall, confident, apparently bullet-proof, he was a regular media face in the 1980s.
But then he pretty much disappeared. When he rang me in Canberra on Thursday morning, he offered a potted version of his life since which incidentally, had involved almost dying, and being rendered so sick and immobilised by diabetes, that ``for seven and a half years, it was just hell on Earth’‘. Which brings me to a why he called.
On Wednesday, Prime Minister Kevin Rudd unveiled the latest plank of his health reform plan. It was a $436 million program to encourage GPs to register and take holistic control of the care of their ever-increasing number of diabetes sufferers. Conservative estimates suggest there will be 2.2 million of them in Australia by the end of the next decade. The plan would involve the GP agreeing to manage the health of the diabetic patient rather than simply referring them to specialists and the like.
I had written the news story noting among other things, that it came as Kevin Rudd looked to secure his 60 per cent federal funding take-over.
The diabetes money was seen ironically, as a ``sweetener’’ to those states because complications from diabetes account for a massive one third of all hospital admissions in Australia. And Australia’s rate of hospital admission is extremely high already by international standards. If local doctors could be encouraged to get more involved with their diabetic patients, many more of them could be kept out of hospitals which would be a big win for the states.
It would be an even bigger win diabetics though because most of those admissions are for serious complications, including strokes, thromboses, renal failure, heart-attacks, and sudden blindness. Amputations from loss of circulation also still occur. Many of these serious conditions could have been avoided if the disease were managed properly. GPs, whose interests are with patients rather than themselves, would jump at this right? Er, no actually.
The doctors’ union, the Australian Medical Association, did not like the idea. It warned for example, that patients would have to forego normal Medicare services if they agreed to participate. That would no doubt frighten some patients but the Government said it was simply not true. Then it said patients could be ``blocked’’ from having a one-on-one relationship with their GP because the practice, rather than an individual doctor would take responsibility for their health.
Again, this is hardly a deal-breaker if it results in better health. Besides, this sacred bond between doctor and patient is hardly working well for many sufferers at present. The AMA’s real beef however, was that it was not adequately consulted. Others groups chimed in as well including the Royal Collage of GPs and the Australian College of Rural and Remote Medicine. For all, the primary criticism of the program - which does not start until mid-2012 anyway so there’s a bit of time to negotiate the details _ seemed to amount to a complaint that it did not come from a full enough consultation process. It seems, being a good idea is no longer enough.
For Ken Cole however, who these days lives in the US, the PM’s announcement was the first chink of light in a steadily darkening situation. ``This is the best thing I’ve seen anywhere around the world,’’ he said branding it ``incredibly progressive, just way ahead of the curve’‘. ``People don’t understand how widespread this problem is becoming and they have no idea how many terrible conditions come from diabetes.’‘
At 66, Cole plays tennis now whenever he can and watches what he eats assiduously. He loves life but recognises that diabetes nearly killed him. For the past 25 years he has injected himself twice a day. As a sportsman, he was fit but admits he used to drink ``massive amounts of Coca-Cola’‘. ``I grew up on the streets in some ways and just didn’t know any better, I didn’t know anything about diet’‘.
It’s a familiar story and it is why diabetes is cutting a swathe through the least well off and least educated particularly in the US and Australia. The most dramatic growth is in the indigenous populations in both countries where the consumption of high sugar junk food diets is rife.
This week, the ABC reported that Coca-Cola had stopped bragging on its website that ``NT had the highest per capita consumption rate of Coca-Cola in the world,’’ in light of the explosion of diabetes in those communities. The University of South Australia’s Professor Kerin O’Dea called on the company to leave the NT.
Ken Cole now speaks with urgency all over the US about the largely unknown epidemic of lifestyle related diabetes pointing out that if you could solve it, you simply would not have the hospital/healthcare problems that threaten to cripple national budgets and hamstring even the most successful economies.
``I’ve been arguing for a decade in the US that if you want to fix Medicare and Medicaid, there’s only two words: `cure diabetes’,’’ he said.
``If you can take away diabetic problems and the massive amounts of drugs and medications that is expended on it, the hospitals would suddenly work again.’‘
He had no doubt that frontline GPs were a huge part of the answer. ``I just think it’s an incredibly progressive move ... I think it’s way ahead of its time and this is the sort of out-of-the-box thinking that just might turn the tide.’‘
If true, you would think the nation’s GPs would be falling over themselves to embrace it.
Maybe it’s not just politicians who have a gap between what they say they represent and whose interests they actually look after.
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