The King and I – Shall we Dance?

Speculation is growing that the King Review – a review of future pharmacy options for the federal government – has been asked to consider two additional options:
* Open ownership including supermarkets and foreign operators.
* A government-owned franchise model involving full nationalisation of the pharmacy sector.
The reasons given for the investigation of these two options is suggested as the only way government can reign in PBS expenditure i.e. full control over drug distribution including dispensing.
And that is a totally unacceptable and invalid proposition.

i2P has previously published an opinion that a Liberal government is hell-bent on privatising Medicare and the PBS, even though it has given public assurances to the contrary.

For the moment there is no hard evidence that the King Review has been given such a brief because the above options began to be circulated in the early hours of April 1 – April Fool’s Day.

The rumours (for that is all they are at the point of i2P picking up the story) will be analysed so that pharmacists can develop strategies to fight these outrageous and completely unnecessary intrusions into their profession by government – should either become a reality.

So what are the established facts leading into the above?
They include:
1. The Liberal Party is a long-term supporter of business –BIG BUSINESS.
While it pays lip service to small business (like community pharmacies) it does not hesitate to discriminate against this sector.
Even Malcolm Turnbull is connected to a Big Pharma that purchased a family business in his wife’s name for $220 million.
It was a business involved in vaccination products and the sale occurred shortly after coercive legislation was successfully introduced by the Liberals that made vaccination virtually a mandatory form of legislation – and a guaranteed return for the Big Pharma involved.

2. The Liberal Party prefers to see private enterprise conducting any major business activity rather than having it state-owned, or dispersed among independent small businesses of limited resources (like pharmacies).
Although Medicare has proven to be the most efficient system to manage a health payments system compared to alternative private options, the Liberals would still philosophically align with a Medicare privatisation, provided it was absorbed into a BIG BUSINESS with sufficient resources so as not to easily fall over.
The fact that the majority of Australian taxpayers have repeatedly endorsed a government-owned Medicare as their ongoing preferred option, does not jibe with Liberal ideology.
And Medicare is one of the very few businesses that government has run successfully.
Big Pharma already supports US-based Patient Benefit Management companies (Medicare equivalent) and large health insurers (PBS equivalent) and given their influence already established through Malcolm Turnbull and others in government, their preferred option will be open ownership of Australian pharmacies – and this will be to the detriment of all Australian taxpayers.
And lobbying dollars here could affect the judgement of any politician – we are talking about a valuable taxpayer-owned and already-established business – just ripe for the picking!

3. The PBS, as a product, is now at the end of its life cycle and government has not been prepared to cope with the fallout this has created (other than attack pharmacists as a “soft” target).
The Pharmacy Guild of Australia (PGA) must also bear a significant responsibility for its failure to help devise a new PBS product alternative with government.
i2P believes that one of the reasons for that failure is that the PGA has been compromised in its dealings with the Department of Health, and for some years now, has not truly represented its members.
It will be interesting to see how committed the PGA will be in defending its members in the immediate future, because either of the above rumour options will demand a full-on and bare-knuckled fight by the whole of pharmacy that has to be united by strong leadership.

4. The Liberal Party has been earlier caught out by its Labor opposition when it began the process of privatising its health responsibilities.
First was the sale of Medibank health fund to private investors and second was the subcontracting of a large slab of Medicare operations procedures to private enterprise interests.
The latter move alienated many traditional conservative voters.
It also points to the rumour of the nationalisation issue not to be a likely outcome, because it does not fit with Liberal ideology.
But it would be a good drum to beat in the event government decides to completely deregulate pharmacy ownership.
Which unpalatable option would you choose?

5. The King Review was given two primary issues for consideration – the location rules and pharmacist-only ownership rules.
While the location rules have had some adverse effects (creating a market for approval numbers that has had the effect of locking out new and younger entrants to pharmacy practice), prospective Big Business owners would, I believe, prefer their retention because it has a stabilisation effect, which further improves long-term value of a community pharmacy investment.
So, i2P has already predicted that location rules would stay in place and that some other alternative should be imposed to open up existing pharmacies to new pharmacist shareholdings.
That location rules will be the least contentious is supported by statements from the Minister for Health and others, that the expected outcome will be their retention.
i2P was initially of the view that location rules were too restrictive, but now views these rules as a reason for government to engage with pharmacy with a range of public/private partnerships in the management of public health.
This would fit Liberal ideology and would need a network of planned outlets (by location rules) and maybe help to offset its guilt feelings as it sells out a profession that has actively sought to cooperate with government in the efficient delivery of the PBS and other areas of health policy (although the many pharmacists who have lost their community practices due to the “transparency” policies may not reciprocate feelings of warmth at this moment in time).

6. This leaves i2P with the firm view that ownership of pharmacies will be deregulated after the King Review has delivered that option as a firm option.
This has always been the long-term view of i2P, and remains so.
All this dancing by government and its front organisation is simply window-dressing and even the April fool’s rumours circulating, may have been invented by the same group of people from government bureaucracy simply playing games.
I would suggest to those people that they should properly earn their taxpayer-funded salaries by coming up with some decent solutions to the PBS mess that you are trying to deflect on to hard-working community pharmacists.

7. I would suggest that for a fuller understanding of the pharmacy transition to open ownership that the following articles be revisited.
They commenced on March 2016:

* The Move Towards PBS Privatisation – It is a Possibility and Could Provide a Wrecking Ball for Community Pharmacy

As pharmacists we think we have seen it all before. But what is currently in motion with our national health system will be so disruptive, the fabric of pharmacy, always efficient and capable of delivering products and services with a high degree of skill and “value-add” will disappear forever. The “wrecking ball” that is gathering pace is set to destroy Australian pharmacy culture completely and what replaces it will simply be an unattractive extension of some globally owned corporation that remains professionally unattractive and more costly for consumers. The loss of “care” as a component of “healthcare” is about to drop off a cliff.

* Understanding the Impacts of a Global Pharmacy Invasion

Deloitte, the global management consultants, have produced a paper based on their investigations as to how the pharmaceutical industry will progress. Their view is that expansion will be vertical with massive operators with marketing power securing wholesalers, insurance companies and patient benefit managers, and horizontally, by purchasing all viable retail pharmacies and squeezing out the competition. Once started in Australia it will be unstoppable and the world of pharmacy will be fully commoditised and not attractive as a career choice. That needs to be fought at every level with every ounce of breath.

* The Corporate Capture of Democracy (and Community Pharmacy)

Most of us are unaware of the fact that to sustain the profit levels of drug companies to the obscene levels they are used to, requires cutting corners and not embracing the same rules as all other smaller businesses. That a large component of that profit is required for “lobbying” efforts to ensure profits keep building means that Big Pharma has to find ways of keeping more patients on the hook at ever increasing prices to sustain their ambitions. This is not sustainable and we, as citizens need to ensure that our politicians work for us – not the drug companies.

* Your Dispensary – Core Business Could Evaporate

Since 2012, Australian Pharmacy has begun a business cycle that will prove to be the most disruptive ever recorded. Pharmacist managers must consider the long-term implications of their decisions against any short-term benefits. Within a decade, pharmacists could become irrelevant unless they build a more resilient and valued skill base. The boundary here is simply what your licence allows – not what other professions or government agencies seek to impose on you. Our collective defence should be to build on our professional “core” in whatever capacity that takes us.

Have you ever wondered why pharmacy ownership is valued by just about every other business model, including major retailers, doctors, medical property developers and even governments – they all want to own us!
This is a testament to all those diligent and ethical pharmacists that have built a reputation and a health service so valued by the general public.
Pharmacy is valuable but because pharmacists are quiet achievers, but they are personally not seen to be the essential value centred in each pharmacy- so these interloper investors are essentially blind and will never build a quality health service provided by independent pharmacists.
One will not function properly without the other, and you cannot beat the proposition of a pharmacist investing their own money in their dream practice and further investing their skills to ensure success – an emotional investment not possible in Big Business ownership.
It is also the reason so many vested interests attempt to pull pharmacy apart by insinuating adverse images through false media reporting.
We can only remain strong by ensuring we get the leaders we deserve and create a cohesive unity – and work needs to occur urgently in this area!

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