Toms Blog

Once again, the Australians have shown the political courage lacking in most of the rest of the world  when it comes to getting a decent mix of public and private in healthcare. Not only did they amaze us all 15 years ago with massive sticks and carrots to get people to take out health insurance, initiatives that continue to be highly successful, now they are IPOing the state owned health insurer, Medibank. This would seem to have several major beneficial effects: releasing an enormous store of value, allowing the government to do something (hopefully) useful with the billions of dollars of proceeds: creating a genuinely level playing field in the PMI market: and allowing Medibank’s board to develop their company in any way it thinks will benefit members, without interference  from nervy politicians and well-meaning civil servants .  I can only admire all this from thousands of miles away and wish Medibank luck. Meanwhile Vhi Dublin, another iFHP founder member who find themselves in a very similar situation vis-à-vis government must be watching extremely closely.


No one can have failed to notice the rapid drop in the price of oil in recent weeks. However most people, if asked, would have no clear idea of the reason for it. This is not least because as usual in life, the low level of the oil price is as they say multifactoral. It starts with the expectation of a fall in demand among the major customers for the stuff, mainly China: and of course the US, once a huge importer, is now thanks to “fracking”, rapidly becoming a net exporter. Another more interesting reason is the strong possibility that the now much-discussed Saudi decision to keep up production, instead of the normal reaction of reducing supply into a weak market may stem from some interesting motives. The Saudi government stands accused, despite their outward steadfastly pro-Western stance, of having supported the very mosques and madrasahs who have convinced so many young men out to terrorise and kill. This may have been an imagined insurance policy against attack from the jihadist wing themselves: whatever the truth of it, they are now terrified of what would happen if or when ISIS turn on them. Could it be that they feel the need to get as much oil out of the ground, and the money safely deposited in the bank, while they still can?  There is another even more interesting reason: they have colluded with their American friends, to let the oil price slide to a point where a massively oil-dependent Kremlin begins to feel the freezing winds of real economic pressure. T’is a funny old world.     


There is no doubt that Ebola, already a catastrophe for parts of West Africa is potentially a major health emergency for the rest of the world. The blame game has started, with the WHO being accused of  reacting too late to the news of the new outbreak. Let me try to mount a defence. It is hard enough for any public body to react in the same way as a commercial organisation: but when that public body is multinational, it is far more difficult. Such bodies naturally become sclerotic and inward-looking , with a tendency to put their energies in to protecting their budgets and fighting internal turf wars, instead of looking after the interests of their clients. But the WHO has a vital role in co-ordinating the response to communicable disease, and we need to support its efforts any way we can: it is good read that Kaiser Permanente are making substantial donations to the key charities in the field. Second, the challenge all of them face in Africa is quite different from dealing with an outbreak in the developed world. We are pretty well attuned to the concept of infection control: patients and their families are generally compliant with the instructions of medical staff. In parts of Africa, illness and death may instinctively involve close (and dangerous) physical contact with families. Getting the necessary behaviour change quick enough to halt accelerating spread will be a huge challenge.