It Is Hard To Believe Any More In The American Alliance – We Are Really On Our Own.

To follow up from yesterday we have:

Cameron Stewart

Donald Trump’s AUKUS embarrassment shows insignificance of deal to the US President

Donald Trump has placed the AUKUS deal under threat.

Updated 5:30PM February 28, 2025

Donald Trump’s failure to recognise the term “AUKUS” was an embarrassment which tells us a few home truths about where this deal - which is central to Australia’s defence planning - ranks in the president’s head.

Trump’s amnesia might have briefly caused hearts to skip in Canberra, but it also won’t matter because in the end Trump is still likely to strongly support the nuclear submarine deal.

Why? Because AUKUS is a very Trumpian deal. Australia pumps an astonishing $US3bn into US submarine production with an expectation – which Trump will never have to honour because it will be beyond his term – that the US eventually sells us three Virginia-class submarines.

Why wouldn’t a transactionally minded American president like that sort of lopsided deal? Yet Trump’s inability to recognise the acronym AUKUS when asked about it in the Oval Office does tell us something about the different weight given to the importance of AUKUS in the US compared to Australia.

Donald Trump has asked what the AUKUS trilateral security partnership is in an Oval Office press conference with British Prime Minister Keir Starmer, where both men talked about the prospects of securing a peace in Eastern Europe.

Yes, as Anthony Albanese and Peter Dutton said, it is easy to trip over acronyms, and yes we shouldn’t read too much into it. But let’s be frank, any previous president would have done the basic preparation to understand the term AUKUS prior to meeting with British leader and AUKUS partner Keir Starmer. The fact that Trump didn’t even know the term suggests he has barely spent any time thinking about it or talking about it with his advisers.

That’s not great news for Australia. Yet that also will make no difference to whether or not Trump ultimately supports the deal. US Defence Secretary Pete Hegseth says that Trump is fully aware of AUKUS and fully supportive of it, while Secretary of State and China hawk Marco Rubio has said AUKUS is “almost a blueprint’’ for how allied nations can work together to confront security challenges.

The Americans will almost certainly love AUKUS during Trump’s four-year term because they don’t need to make any hard decisions in relation to it. Until the end of this decade they just have to accept pots of money from Australia, which last month handed over a cheque for $800m as the first instalment of the eventual $US3bn to speed up the production of the Virginia-class submarines.

US President Donald Trump has remarked on the AUKUS alliance during his meeting with UK Prime Minister Keir Starmer.

It is the president who succeeds Trump who will have to make the hard decisions on AUKUS and this is where the issue becomes murky for Australia. At that point the then-US president will have the power to halt the planned sale of Virginia-class submarines to Australia from 2032 if it is judged that the loss of those submarines from the US fleet will undermine the fighting capabilities of the US military.

Given that the production of Virginia-class submarines is currently way behind schedule and unlikely to catch up by the 2030s when the sale to Australia is supposed to take place, it would be an easy argument for a president – backed by a hawkish congress – to make. That is when the going gets tough for AUKUS and for Australia. But not for Trump, who just has to kick back in the Oval Office and watch Australian taxpayers pour a small fortune into the US shipbuilding industry. Given that, why wouldn’t he support AUKUS, or whatever it’s called?

Here is the link:

https://www.theaustralian.com.au/nation/defence/donald-trump-will-come-to-love-aukus-even-if-he-cant-remember-its-name/news-story/96e43f9a0e5be2ebbabbd175f2df373c

I will stop chatting about this topic now as I believe the point has been made! There is nothing tat Marles or Albanese can say can change the fact that basically we are on our own in a way not seen since the imminent Japanese invasion of OZ in 1940/1.

Time to change a few spending priorities and shore up a few real alliances – like those with Europe and Asia. With Trump in charge I would not trust Trump as far as I could throw him!

David.

All I Can Say Is That I Am Sure He Is Right! We Also Really Need To Get Our Defence Act Together!

This appeared a few days ago:

François Hollande says Europe, abandoned by its former ally, must rearm fast

Donald Trump has shattered the principles on which the Western alliance rested, argues the former French president

Mar 7th 2025

WE NEED TO be clear: while the American people may still be our friends, the Trump administration is no longer our ally. This is grave. It marks a fundamental break with the historic relationship between Europe and America and the link established after the second world war with the creation of the Atlantic alliance. It is unfortunately, however, indisputable. It is no longer merely a question of declarations designed to dumbfound, but of actions that mark much more than a disengagement: a strategic about-turn combined with an ideological confrontation. The signs of this reversal have been accumulating in recent weeks. The bewildering and degrading scenes in the Oval Office were the illuminating culmination.

In addition to this reversal of responsibility for the outbreak of war in Ukraine, with Volodymyr Zelensky portrayed as a dictator and Vladimir Putin as a leader respectable enough to be a regular interlocutor, there has been an unrestrained attack on the principles on which the Western alliance was previously founded.

At the recent Munich Security Conference, the American vice-president, J.D. Vance, said that European countries were constraining freedom of expression if they did not allow just about anything to be posted on digital platforms and if they did not give free rein to the most reactionary forces.

Faced with this sudden turnaround, which everything suggests is irreversible, there are several possible courses of action. To accept it implies working with the logic of transactional diplomacy. It would mean following Donald Trump in his operation to carve up Ukraine, and a victory for Mr Putin with no guarantee that Russia would stop there. It would also mean that those countries in the NATO alliance that still want to benefit from the American security umbrella would be obliged to buy large quantities of American military equipment.

Another option would be to hope, through a vigorous dialogue, that France, the European Union, Britain and other countries can manage to convince Mr Trump and to demonstrate to him that it is not in America’s interest to turn Russia’s aggression against Ukraine into a precedent from which other powers could draw inspiration: China in relation to Taiwan, but also Iran in the Middle East, or North Korea in relation to South Korea.

It is the role of diplomacy to be the voice of reason and to use every argument to avoid the worst. I fear that it will not get very far. Let’s not forget that the American president tore up the Paris agreement on climate change during his first term in office, as he did with the one concerning Iran’s nuclear programme.

So we have to admit that our alliance with America is broken for the foreseeable future, and draw all the consequences. I can think of at least three.

The first is that we must continue to intensify our aid to Ukraine. This means seriously increasing the French contribution, which is currently particularly low compared with that of Germany or Britain.

The second is the need to prioritise providing Ukraine with security guarantees. It is too early to define the form these will take or to talk about the presence of soldiers on the ground. But it is clear that if Europe wants to protect its current borders, it must shoulder its share of responsibility for the security of its closest neighbour, especially if America abdicates this responsibility.

The third consequence is the urgency of accelerating European defence spending and beefing up European capabilities. To be sure, the Ukrainian conflict has led to progress in the quest for co-operation and in the co-ordination of our respective armies’ equipment. However, this progress pales into insignificance next to the scale of the threat. It is true that a European fund has been set up, but the amount remains modest and its use unclear. It is to be hoped that the European Commission gives itself a borrowing capacity to supplement the military expenditure of member states.

Clearly, Europe must agree to make additional budgetary efforts, even if France, Britain and Poland have already done a great deal, while others have remained at inappropriate levels. That said, France, Britain and Germany together spend more on defence than Russia. So it is not merely a question of the amount, but of organisation, the pooling of armaments and the integration of forces.

Let’s be frank: this “defence” cannot be achieved by a Europe of 27. Some countries are Russia’s allies, such as Hungary under Viktor Orban and Slovakia under Robert Fico. Italy under Giorgia Meloni is so closely linked to the Trump administration that she took part in the Conservative Political Action Conference, where Steve Bannon made a Nazi-style salute. Others still are so tied to America that they are not prepared to go as far as to seek autonomy within NATO. The only method that works is that of accelerated co-operation between those who are willing to act.

Finally, were there to be an even deeper misunderstanding between America and Europe, and should the American umbrella no longer be open even in stormy times, France and Britain would have to ask themselves what their vital interests mean in order to determine their doctrine on nuclear deterrence. France will never share decision-making, but it can determine its scope.

In the space of a few weeks, the threats have not changed: the aggressiveness of Mr Putin’s Russia, the ambitions of China, the rise of nationalism and the persistence of Islamist terrorism. What has changed is that we Europeans are on our own, as we have been at other times in our history, and that our main ally is now challenging the rule of law, questioning our economic and commercial interests, and supporting and encouraging extreme-right movements in the elections of our respective nations. Faced with might, we must be strong. Faced with fracture, we must be united. Faced with fear, we must be courageous. This applies to Europe, but first and foremost to France. ■

François Hollande was president of France from 2012 to 2017.

Here is the link

https://www.economist.com/by-invitation/2025/03/07/francois-hollande-says-europe-abandoned-by-its-former-ally-must-rearm-fast 

To me there is no doubt the world is becoming a much more dangerous place and Australia really needs to start paying even more attention than has been our usual to the world around us. Our geography really does lead to a level of complacency we need to overcome, and the time has more than come to get our defense act together!

Do you agree?

David. 

AusHealthIT Poll Number 784 – Results – 9 March 2025.

Here are the results of the poll.

Do You Think President Trump Can Be Relied On As A Trustworthy Alliance Partner For Australia?

Yes                                                                      1 (3%)

No                                                                    28 (97%)

I Have No Idea                                                  0 (0%)

Total No. Of Votes: 29

An interesting outcome with pretty much a total majority having no trust in Trump. They are right of course! That he will be around for 4 years I find very worrying – to say the least. The man is a dangerous menace to the world!

Any insights on the poll are welcome, as a comment, as usual!

Fair voter turnout. 

0 of 29 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

It Is Interesting To See How Divorce Is Evolving In Australia!

This interesting article appeared last week:

Divorce in Australia: What’s the ‘peak age’? And why are more long marriages ending?

Divorce in Australia is changing. Why are couples taking longer to call it quits?

Stephen Lunn

28 February, 2028

If you think sailing through the seven-year itch and beyond means you’ll be cosying up with your beloved til death do you part, think again.

The fact is Australian men and women are divorcing later and later in life, and 20-plus-year marriages make up a growing proportion of the nation’s divorces.

But don’t believe that old chestnut that half of all marriages end in divorce. It’s more likely around three in 10.

Overall, Australia’s divorce rate has been on a steady decline over the 50 years since no-fault divorce was introduced in the 1970s, but a deeper dive into the data offers a fascinating glimpse of how and why Australians are getting together and moving apart.

Divorces dive

Why has Australia’s divorce rate hit an all-time low?

According to the latest available Australian Bureau of Statistics data, it reached its lowest point in 2023, at 2.3 divorces per 1000 residents aged 16 and over. That’s almost half what it was in 1980.

It’s less a sign of growing domestic bliss than a reflection of society’s changing attitudes to marriage, says Australian Institute of Family Studies senior researcher Lixia Qu.

An increasing proportion of divorces in Australia involve marriages of 20 years or more, new research reveals.

“These days most couples live together before getting married – if they marry at all – which was unusual 50 years ago,” says Dr Qu, author of a new report Divorces in Australia, Facts and Figures 2024.

“Being able to ‘try before you buy’ was less of an option for young couples in the 1970s and earlier, due to stigma and societal expectations.”

Dr Qu says despite the declining number of divorces, relationships aren’t necessarily longer these days.

“In 2023, 83 per cent of couples had been living together before marriage, compared to just 16 per cent in 1975. Many couples separate without entering into marriage, which is not captured in the divorce statistics,” she says.

What is ‘peak’ divorce age?

The median age at divorce hasn’t been older since this data started to be collected in the 1970s. For men it is now 47.1 years and for women 44.1 years as at 2023, compared to 35.3 years for men and 32.7 years for women in 1980.

This is a different question from the most likely age to be divorced, which tends to coalesce around younger married people.

For married men it is between 25 and 29 and for married women it is highest at 24 and under, closely followed by the years from 25 to 29.

Younger people who have married at this age may have jumped in when their friends in relationships wait, or choose to live together.

Married or not, those in their 20s, especially their early and mid-20s, are still developing and maturing in various aspects of their life, including their communication with each other. There is also potentially financial pressure given they are still establishing themselves in their careers.

And at this age, uncoupling may be less emotionally complex given many will be able to do so without the complication of children.

All that said, the pattern of divorce across a couple of generations shows that those divorce rates among younger people, especially women, are dropping, while the rate among older people is increasing later in life.

The rise in divorce among 20+ year marriages

In 1980, marriages of less than five years’ duration made up more than 20 per cent of all divorces, but by 2023 that proportion had fallen to 11.7 per cent.

By contrast, 19.8 per cent of all divorces in 1980 involved marriages of 20 years or more, whereas in 2023 it was almost 30 per cent.

Overall, the median duration of a marriage that ends in divorce in Australia is between 12 and 13 years, an increase from 10 years in 1990.

“Compared to 40 or 50 years ago, more women have a degree of financial independence, and they also are more likely to be working, so this gives them more options in terms of staying in a marriage or not,” Dr Qu says.

“Women continue to be worse off than men after separation, with many having stepped back to part-time or no work during their children’s early lives, but often now there is at least some financial foundation to separate.

“Another reason is our longer life expectancy. People, even in long marriages, may feel there should be more to life. They may be looking ahead and thinking I don’t want to be unhappy for decades.

“More people in their 50s and 60s are still working full-time, still looking forward to much more life than perhaps the same people at that age half a century ago,” Dr Qu says.

So is there any sense that the HSC (or VCE) divorce is a real social trend?

Couples with children have an extra layer of complication when their marriage breaks down. About 47 per cent of divorces involve children under the age of 18.

Anecdotes abound of couples saying they’ll stick it out until their youngest finishes high school before separating. Whether this is a good thing for either the couple themselves, or the children, is open to question.

“I don’t have definitive data on the reason more people are leaving marriage after 20-something years, but people do worry about the impact of separation on their children, so along with those other factors around more financial independence for women and a sense that it is not too late to chase happiness, this theory does ring true.”

The AIFS report shows the proportion of divorces involving children under 18 has fallen from over 60 per cent in 1980 to about 47 per cent in 2023.

Are we out of love with marriage?

Apart from the post-Covid catch up of marriages, the marriage rate has continued a long-term decline as couples are increasingly willing to live together without a formal piece of paper.

This is particularly true of people who have been previously married. In 2023, 74 per cent of marriages were the first marriage of both partners, a percentage that has climbed since the early 2000s.

And forget what you’ve heard about a trend back to kids getting married younger these days. The data doesn’t lie, showing a steady increase in the age at which they enter their first marriage.

From 21 for women and 23 for men in the mid-1970s it now sits at 30.1 years for women and 31.4 years for men.

One of the main reasons is that sex before marriage is not as big a deal. Males and females still living in their parents homes are more likely to be able to sleep with each other without it being an issue.

And many more younger couples live together without being married. In fact, the 2021 Census data shows that people aged 25-29 were more likely to be living with a partner and not married than being married. For those living out of their parents’ home it was a pattern even more evident for those in their early 20s.

The delay in marriage may also be put down to men and women spending much more time in post-school education. More people in higher education for longer delays the start of paid jobs that is a critical part of the life course, often coming before marriage.

The high cost of housing also means young men and women are living with their parents longer, which again delays the start of those life-course decisions. This is not just behind the later median age of marriage, but also why the nation’s birthrate is at an all-time low.

The gender gap in median age at first marriage has narrowed in the past few decades from 2.3 years in 1980 to 1.3 years now.

And confirming Dr Qu’s “try before you buy” thesis, by 2023, 83 per cent of couples have lived together before getting married compared to just 23 per cent in 1979.

Here is the link:

https://www.theaustralian.com.au/health/relationships/divorce-in-australia-whats-the-peak-age-and-why-are-more-long-marriages-ending/news-story/e2fa610dcf410683c362edf8acdc95ea

I found this a fascinating collection of statistics and well worth a browse!

David.

 

I Suspect We May Not Yet Realise Just How Alone Australia Is On The World Stage!

This appeared last week:

Zelensky, Trump clash in bitter Oval Office talks

Steve Holland, Nandita Bose and Jeff Mason

Updated Mar 1, 2025 – 11.22am, first published at 4.45am

Washington | Volodymyr Zelensky and Donald Trump clashed publicly at the White House, during which the Ukrainian leader was berated for being both disrespectful and not thankful enough to Trump and the US in general.

Plans to hold a signing ceremony between the two leaders on a resources’ agreement, demanded by Trump, were cancelled. A joint press conference also was cancelled. Zelensky was soon afterwards escorted to his vehicle by a protocol official.

The visit by Zelensky had been designed to help Ukraine convince the US not to side with Russian President Vladimir Putin, who ordered the invasion of Ukraine three years ago.

The meeting quickly devolved into a shouting match between Trump, vice president J.D. Vance and Zelensky. For his part, Trump insisted Zelensky was losing the war and said, “people are dying, you’re running low on soldiers”.

Trump then threatened to withdraw US support. “You’re either going to make a deal, or we’re out, and if we’re out, you’ll fight it out. I don’t think it’s going to be pretty,” Trump said.

“You don’t have the cards. Once we sign that deal, you’re in a much better position. But you’re not acting at all thankful, and that’s not a nice thing. I’ll be honest. That’s not a nice thing.”

Zelensky pushed back, openly challenging Trump over his softer approach toward Putin, urging him to “make no compromises with a killer”.

Trump stressed that Putin wants to make a deal. “You are gambling with World War Three,” Trump told Zelensky at one point, urging him to be more thankful.

Zelensky also pushed back on Trump’s claims that Ukrainian cities have been reduced to rubble by three years of war.

Former Russian president Dmitry Medvedev appeared to revel in the spectacle, writing on Telegram that Trump had delivered the “truth” to Zelensky and saying the Ukrainian leader had received a “brutal dressing down”. He called for military aid to Ukraine to be halted, something Moscow has long been pushing for.

Russian Foreign Ministry spokeswoman Maria Zakharova said it was a miracle that Trump and Vance had restrained themselves from hitting Zelensky.

Russia has long portrayed Zelensky as an unstable and self-obsessed US puppet who was used by the previous Biden administration to try to inflict a strategic defeat on Moscow by “fighting to the last Ukrainian”. Zelensky has rejected that characterisation.

Trump calls for ‘immediate’ ceasefire

Hours after the meeting with Zelensky, Trump said he wanted an “immediate” ceasefire between Russia and Ukraine, and warned Zelensky to make peace or lose American support.

“That was not a man that wanted to make peace,” Trump said to reporters before flying to Florida. He added, “I want a ceasefire now”.

Trump said he believed that Putin was ready for a peace deal.

Zelensky made an appearance on Fox News on Friday evening, in which he said his public spat with Trump and Vance was “not good for both sides”. But Zelensky said Trump needs to understand that Ukraine can’t change its attitudes toward Russia on a dime.

Zelensky added that Ukraine won’t enter peace talks with Russia until it has security guarantees against another offensive.

“It’s so sensitive for our people,” Zelensky said. “And they just want to hear that America (is) on our side, that America will stay with us. Not with Russia, with us. That’s it.”

‘You didn’t say thank you’

The White House clash undermined efforts by European leaders – from France and the UK this week – to convince Trump to provide security guarantees for Ukraine even if he has refused to deploy US soldiers on Ukrainian soil to maintain peace.

During the confrontation between Trump and Zelensky, Vance interjected that it was disrespectful of Zelensky to come to the Oval Office to litigate his position, a point Trump agreed with.

“You didn’t say thank you,” Vance said. Zelensky, raising his voice, responded: “I said a lot of times thank you to American people.”

Shortly after Zelensky left the White House, Trump posted on his social media site Truth Social that Zelensky “is not ready for peace”.

“I have determined that President Zelensky is not ready for Peace if America is involved, because he feels our involvement gives him a big advantage in negotiations. I don’t want advantage, I want PEACE. He disrespected the United States of America in its cherished Oval Office. He can come back when he is ready for Peace.”

Trump last week called Zelensky a “dictator”.

Zelensky repeatedly defended his nation, and its determination for a “lasting peace”, which he did again in a post on X following the White House meeting.

European leaders – including those from Germany, Poland, Spain, Norway, Sweden, the Czech Republic, Latvia, Lithuania and Moldova – rallied behind Zelensky in posts on X.

Moldova President Maia Sandu said: “The truth is simple. Russia invaded Ukraine. Russia is the aggressor. Ukraine defends its freedom—and ours. We stand with Ukraine.”

‘Better war, than shameful peace’

Ursula von der Leyen, president of the European Commission, posted: “Your dignity honours the bravery of the Ukrainian people. Be strong, be brave, be fearless. You are never alone, dear President @ZelenskyyUa. We will continue working with you for a just and lasting peace.”

French President Emmanuel Macron spoke by phone with Zelensky after he left the White House, the Élysée palace said. “We must ... respect those who have been fighting since the beginning,” Macron earlier told reporters in Portugal.

Just the word “wow” is how Oleksandr, 40, a Ukrainian military officer fighting in Russia’s Kursk region, responded to the footage of the argument.

“We still have a lot of work to be done,” he wrote. “Better war, than shameful peace.”

Earlier, Trump welcomed Zelensky on his arrival at the White House before they headed for talks, lunch and then a joint press conference where they were to sign the agreement.

“I hope I’m going to be remembered as a peacemaker,” Trump said.

Trump told Zelensky that his soldiers have been unbelievably brave and that the United States wants to see an end to the fighting and the money put to “different kinds of use like rebuilding”.

Trump has adopted a much less committed stance toward European security, a change in tone that has sent shockwaves across Europe and stoked fears in Kyiv and among its allies that it could be forced into a peace deal that favours Russia.

With files from AP, Washington Post

Reuters

Here is the link:

https://www.afr.com/world/europe/zelensky-trump-clash-in-bitter-oval-office-talks-20250301-p5lg31

With what has happened in the last week of so it is hard not to conclude that Donald Trump is not someone you would willingly trust to be in your corner and to me that means Australia needs to re-calibrate how we are going to proceed in the world!

We need to re-asses all our alliances and linkages and challenge all our old assumptions based on the “American Alliance” which is now defunct to a large degree. I would not trust Trump or Vance as far as I could throw them and I reckon Australia should plan accordingly – seeking to bolster alliances that we might be able to trust. The UK, Europe and India, as well as the friendly states closer, need a lot more work as do efforts to improve economic links with Asia and China. We ae more on our own than ever and we need to plan for this.

Anyone got other clever thoughts?  Scandinavia has some smart nations we should become more way friendly with I reckon! Ukraine also should be fostered!

We are on our own, the US cannot be relied upon, and we need to forge our own path I believe…

What do you think?

David.

Labor Is Going Pretty Hard On The Urgent Care Clinics. Too Soon To Tell How Useful They Are!

Labor seems to be convinced they are a “good thing”!

Here is the latest announcement…..

Labor vows $644m for additional 50 urgent care clinics if re-elected

By Paul Sakkal

March 1, 2025 — 10.30pm

Dozens more urgent care clinics will be built by the Albanese government if it is re-elected at the coming election, in a $644 million expansion of a scheme Labor regards as a big vote-winner.

Prime Minister Anthony Albanese is expected to call an election soon – with April 12 firming as a probable date – and on Sunday will add another plank to his health-focused agenda, taking Labor’s Medicare pledges over recent weeks to almost $10 billion.

Spending on the suburban and regional clinics, which Labor marginal seat MPs say have been politically popular as alternatives to hospitals, is also designed to sharpen Labor’s contrast with Peter Dutton, whom it is desperate to frame as a risk to public health funding ahead of what looms as a tight election.

Albanese said the 50 extra clinics would build on the 87 already opened this term, and that the new facilities would be constructed in 2025-26.

“Four in five Australians will live within a 20-minute drive of a bulk-billed Medicare urgent care clinic once all Labor’s clinics are open,” Albanese said in a written statement.

Health Minister Mark Butler said: “You can’t trust [the Coalition] to keep them open”, setting up another test for Dutton after the opposition immediately backed Labor’s $8.5 billion free GP pledge last Sunday despite the budget being in structural deficit.

The adoption of such a big spending item displayed the political sensitivity of healthcare and the opposition’s eagerness to neutralise Labor’s attack, which carries echoes of the 2016 “Mediscare” campaign waged against Malcolm Turnbull. The line has particular potential to cut through because Peter Dutton was health minister when the Abbott government tried to create a GP co-payment.

Two senior opposition sources, not permitted to talk openly about shadow cabinet, said Dutton was preparing an expensive health policy of his own, making it easier to support Labor’s spending as the opposition struggles to find savings to bolster its budget bottom line. The $644 million clinic pitch was funded in December’s mid-year budget update, the government confirmed.

It is unclear, however, if the opposition will support the urgent care investment. The information contained in this story was provided by the government on an embargoed basis that prohibits questions being asked of non-government parties.

While the precise locations are yet to be finalised, 14 clinics would be opened in NSW at Bathurst, Bega, Burwood, Chatswood, Dee Why, Green Valley and surrounds, Maitland, Marrickville, Nowra, Rouse Hill, Shellharbour, Terrigal, Tweed Valley and Windsor.

Twelve would be built in Victoria at Bayside, Clifton Hill, Coburg, Diamond Creek and surrounds, Lilydale, Pakenham, Somerville, Stonnington, Sunshine, Torquay, Warrnambool and Warragul.

And in Queensland there would be new sites at Brisbane, Buderim, Burpengary, Cairns, Caloundra, Capalaba, Carindale, Gladstone, Greenslopes and surrounds, and Mackay.

Health and aged care is rated as the top issue for 7 per cent of voters, according to the latest Resolve Political Monitor, well behind the cost of living (53 per cent), but ahead of topics such as immigration (4 per cent) and similar to crime (9 per cent).

This masthead reported on January 1 that Labor would put bulk-billing and urgent care clinics at the centre of its campaign pitch.

Labor had a six-point lead on the Coalition on health policy in the Resolve poll in April last year, but this has turned into a three-point deficit as ratings of Labor’s performance in all areas have trended downward along with its level of core political support amid an inflation crisis.

Here is the link:

https://www.smh.com.au/politics/federal/labor-vows-644m-for-additional-50-urgent-care-clinics-if-re-elected-20250301-p5lg4p.html

It is interesting that Labor is increasingly not seen as totally credible with health service delivery as indicated in the article above – but it is hard to draw much from these findings. I am sure things will firm up when the election is called.

Recent commentary is not all that keen on the UCCs.

07 February 2025

Urgent Care Clinics aren’t showing their worth

By

Laura Woodrow

Medicare Urgent Care Clinics and the triple bulk billing incentives were central to the government’s campaign to support the health system. But are they working?

Potentially avoidable GP-type presentations to ED aren’t going down, but bulk billing rates are, according to this year’s Report on Government Services.

The federal government began rolling out Medicare Urgent Care Clinics from July 2023 , alongside a promise that they would ease the pressure on emergency departments.

But according to the 2025 Report on Government Services, released last night, GP-type presentations to EDs remained largely stagnant at 2.8 million between 2022-23 and 2023-24.

Potentially avoidable GP-type presentation to EDs had remained fairly consistent since 2014-15 but did rise to 3 million and 3.1 million during covid in 2021-22 and 2020-21 respectively.

Speaking to The Medical Republic, RACGP president Dr Michael Wright said that the data showed the MUCCs weren’t yet showing their worth.

“Importantly, [the data] show that the preventable hospitalisations have been pretty stable for the last decade, despite talk that there is increasing pressure on hospitals, these data don’t tend to reflect that,” he said.

“It also shows that the UCCs to date haven’t had an impact either.”

AMA president Dr Danielle McMullen agreed.

“It shows that UCCs haven’t necessarily reduced the demand on hospitals, and also that it’s really important that we don’t blame patients for where to go,” she told TMR

“Patients don’t always know what’s an emergency and what’s not.

“What we should be working together on is how to support patients to access the right care at the right time, and we know that investing in general practice to provide more urgent appointments and acute care within mainstream general practice helps maintain that continuity of care.

“We think would be a better investment than more urgent care centers.”

In late 2023, the government also introduced the triple bulk billing incentive.

This measure was explicitly targeted toward concession card holders and children, but there was hope that the extra funding would allow GPs to lower private fees across the board.

This has not borne out.

The national total expenditure per person on general practice did increase in real terms, from $440 in 2022-23 to $452 per person in 2023-24, taking inflation into account.

This increase did not align with an overall drop in costs to patients or an overall increase in bulk billing.

Dr Wright said the small increase in per person funding “was better than a decrease” but it followed a considerable drop over recent years, with 2022-23 seeing the lowest per-person expenditure for a decade.

“There is a small increase here, and that reflects the impact of the tripling of the bulk billing incentives which did help some GPs to continue to bulk bill more concession card holders and pensioners, but we need more than those incentives to support access to care to all Australians,” he said.

“We definitely need to do a lot more to reinvest in Medicare and provide greater support for general practice.

“All Australians deserve affordable access to general practice.”

Despite the triple bulk billing injection, bulk billing has continued to decline overall.

In 2023-24, 47.7% of patients were fully bulk billed, a decrease from 51.7% in 2022-23.

“It just shows that we need to focus not only on supporting bulk billing, but we also need to decrease out of pocket costs for patients who aren’t being bulk billed. That requires a more comprehensive investment in Medicare rebates,” said Dr Wright.

Over 2023-24, the average out-of-pocket costs for a patient to see a GP sat at $45, preceded allied health, $68, and specialists, $117.

High costs caused 8.8% of respondents who needed to see a GP to delay or forgo appointments, the highest proportion since 2014-15.

This continued a year-on-year increase since 2020-21, when the proportion was 2.4%.

Around 8% of respondents delayed filling or did not fill a prescription due to costs, which was also the highest proportion recorded since 2014-15, continuing a year-by-year increase from 4.4% in 2020-21.

In total over the last financial year, 77.3% of non-referred GP services were bulk billed, and 28.7% of specialist services.

In terms of the workforce, the number of GPs per 100,000 people dropped by almost 5% between 2022 and 2023.

It now sits at 109.7, leaving 39,449 GPs in total across the nation, 29,215 of whom are on a full-time equivalent basis.

“Nationally in 2023, the number of FTE GPs per 100,000 people decreased as remoteness increased (111.8 GPs per 100,000 people in major cities compared to 87.3 GPs per 100,000 people in outer regional, remote and very remote areas),” read the report.

Dr Wright said this showed the need for more GPs in communities and across Australia.

“It’s a concern that the GP numbers are dropping, when we’ve never needed [GPs] more… with our aging population, a growing population, more people living with chronic health conditions,” he said.

“We really need to increase access to GP services, which involves training more GPs, and we need to make care more affordable for patients, and that involves increasing the medical Medicare rebates.”

In terms of workforce sustainability, in 2023 26.6% of full time GPs were aged 60 years or older, compared to 1.5% who were less than 30 years of age.

“This is the equal highest proportion of GPs aged 60 years or older and the equal lowest proportion of GPs who were less than 30 years old across the reported nine-year time series (equal with 2022),” read the report.

The proportion of GPs who exited the GP workforce in 2023 was 1.4% nationally.

Here is the link:

https://www.medicalrepublic.com.au/urgent-care-clinics-arent-showing-their-worth/114334

It looks like it is not yet totally clear just what value will flow from the UCCs. While politically they sound good we have yet to see them in place for long enough to know a final verdict on how well they work.

As people get used to them clearer answers may emerge – but not before the election I am pretty sure!

David.

The New England Journal Of Medicine Comments On The Trump Administration....

 This appeared recently:

Order out of Chaos

Author: Eric J. Rubin, M.D., Ph.D. Author Info & Affiliations

Published March 3, 2025

DOI: 10.1056/NEJMe2502874

Copyright © 2025

The young woman and her husband were terrified. Her first pregnancy had been difficult, although she had eventually given birth to a healthy boy. But she’d had two subsequent miscarriages. Now, despite another rocky course, she’d carried a baby almost to full term. But something was very wrong. The obstetrician and nurse spoke quietly to each other while the woman’s contractions continued. When the baby was finally delivered, he was pale and swollen. The obstetrician offered him to the mother to hold while the baby took his last few breaths.

This is the story my parents told me about my brother Alan. My mother was Rh-negative, while my father was Rh-positive. As a medical student, I put it together — my birth had induced antibodies to Rhesus factor, and Alan had developed immune hemolytic disease of the newborn. It is a disease of largely historical significance that is now almost completely preventable with the administration of RhoD immune globulin. Unfortunately, this agent came almost a decade too late for Alan.

But it did come, an early product of a new and substantial investment in medical research. Its development has been followed by multiple miracles — the transformation of childhood leukemias into curable diseases, immunotherapy for some tumors even when they are widely metastatic, and the restoration of normal function in many people with cystic fibrosis, to name just a few of many breakthroughs. And this research has been an enormous economic engine for the United States, generating tens of billions of dollars annually and more than 400,000 jobs. It’s difficult to imagine an investment that has paid more dividends, both in bettering the health of Americans and in making the United States the global leader in life science — which is why the current administration’s seemingly random assault on scientific research is so puzzling.

The raft of executive orders issued by this administration and the judicial responses to them have been dizzying, and chaos seems to reign. Collectively, these actions have crippled many of the institutions we rely on to promote and improve health. The National Institutes of Health (NIH) is a jewel, and the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) set the international standard for monitoring health and maintaining safety. The President’s Emergency Plan for AIDS Relief (PEPFAR) has by itself saved millions of lives. And even more innovation comes from externally funded university and hospital labs. Already, as funding is disrupted and funding decisions suspended, many people have lost their jobs, new hiring is frozen, patients are losing access to life-saving treatments, and research is being interrupted, sometimes with tragic and expensive consequences. Research studies, once stopped, cannot necessarily be restarted. And the longer this chaos persists, the greater the damage will be.

The editors of the Journal are clinicians, researchers, and patients. We strive to care for anyone who needs help, we write and review grants, and we serve on federal advisory committees. We join our colleagues in celebrating every new and exciting medical insight that can lead to longer and healthier lives (even when the findings are published elsewhere). In other words, we are members of the same communities as our readers and authors, and today we share their pain and their concerns about the threats to health.

What can we do to counter the current chaos? At the least, we can try to maintain order. In our roles as editors, this means continuing to do what we think makes a difference: publishing the highest-quality research, analysis, opinion, and educational content that can improve patient health. We are proud of our communities, and we seek to provide a platform where authors can speak out, even when topics are controversial.

I never met Alan. But I hope that the research continues that will allow others to meet their future family members.

Notes

This editorial was published on March 3, 2025, at NEJM.org.

Disclosure forms provided by the author are available with the full text of this editorial at NEJM.org.

Supplementary Material

Disclosure Forms (nejme2502874_disclosures.pdf)

Here is the link:

https://www.nejm.org/doi/full/10.1056/NEJMe2502874?query=RP 

Heaven help us all. They have collectively "slipped their moorings"

David.