Not for the first time, some Australian politicians are in trouble over their use of very generous travel entitlements. We discuss why it matters for patients and why the claim that they are acting within the rules does not stack up.

A turbulent round of Senate Estimates, highlighted by a heartbreaking exchange about a mother with two children battling Crohn’s disease. Officials suggested that the family seek compassionate access from companies or seek treatment at a public hospital. We also canvass ‘MFN’ pricing risks, FOI controversies, ministerial travel blowouts and looming budget pressures that do not operate according to what might be a common understanding.

In this week’s Dispatched Podcast, we unpack the AI Health Summit and agree it revealed a gap between institutional caution and the real-world pace of its adoption. The practical reality of the proposed ban on genetic testing for life insurance, the self-limiting nature of Australia’s health reform processes, the status quo bias, and the absence of any genuine patient-centred purpose in current settings. We also discuss productivity, a critical roundtable, access inequities and the opportunity to broaden the discussion by not accepting the ‘framing’ of choices.

Reform efforts can struggle because they focus on health systems at their strongest point rather than their weakest. Framing is a pernicious tool used to justify delays and denials. We argue that the uptake of GLP-1 therapies in the US is delivering remarkable results, and that we need to apply the lessons from that experience in Australia, challenging institutional narratives and reframing the public debate to focus on public health benefits.

We discuss what could be a significant policy shift in PBS decision-making, with clinical judgement backed by what is a 'common sense' outcome. It could be a new precedent, but only if all stakeholders demand clarity on the criteria so that it can be applied more broadly. We also reflect on patient advocacy in New Zealand, where access has become a political issue and the focus of a significant discussion at this week's Valuing Life Summit in Wellington.

Has Senate Estimates devolved into an overly polite, time-sliced format that enables waffle, obfuscation, and endless questions taken on notice? Does this reflect weakened scrutiny? The responses provided revealed the truth of review processes, which aim to protect institutional power, blame outsiders for problems, and generally add complexity to existing problems. Few appear willing to say the quiet part out loud.

Listen on Apple or Spotify.

We open by marking Yom Kippur and a frank discussion before pivoting to the US 'MFN' drug-pricing moves, what they could mean for Australia’s PBS, and why institutional rigidity in HTA persists and is worsening. Medical research funding rhetoric versus slow progress in PBS and health technology access, hospital funding and NDIS pressures, and the expansion of pharmacist prescribing, as well as the need for subsidised pharmacy services.