28-Sep-2011 
WHEN Queensland grandfather of five John Charles suffered cramping and seizing in his leg about five years ago, he reckoned he could cope.
When it got worse, making him limp, the warehouse worker who had spent years lifting heavy cartons on to pallets thought he could cope with that, too.
But by the time he was "hobbling to work and hobbling out again", even he was having doubts. Tests showed degeneration of his right hip, which was soon so painful that work became impossible and he would wake up screaming when he rolled over in his sleep.
For previous generations, episodes such as this would have been the downward stepping stones to the loss of independent living. But we - in Australia, at least - live in more fortunate times.
"My GP wrote a letter to Ipswich Hospital and they put me on the waiting list [for a hip replacement]," the 64-year-old recalls.
On April 29 last year, after a worsening of his condition saw him moved up the queue and treated as a private patient at Brisbane's public Princess Alexandra Hospital, Charles, who has not worked since his operations, was fitted with a prosthetic hip.
A year later, on April 28, his left hip was also replaced.
The taxpayer picked up the cost of the devices, estimated to be $12,000 each.
As Charles did not have private health insurance, he estimates the two operations together cost him personally about $10,000, being the fees for the surgeon, anaesthetist and other staff, as well as some tests. "It was worth 10 times that," he says.
"I'm doing a bit of bushwalking again and I'm looking forward to summer, when I can go swimming in the ocean."
Asked what is the most important thing his new hips have allowed him to do again, Charles replies: "I can smile."
After a lifetime of paying taxes, few would begrudge him the surgery that has restored not only his mobility but also his joie de vivre.
Instead, the question this poses is not for individuals but the system: with so many more people entering the age range where operations such as this become common, how will the country afford the care its inhabitants expect?
The growing fear has been that, without reforms, it will not; which raises further questions: Are we doing enough to cope with the pressures? And what useful reforms might we be overlooking?
While the solutions are hard the problem is easy to grasp. It comes down to basic arithmetic, some of which is eye-popping.
The number of Australians aged 65 and older, which was about 14 per cent of the population last year, is expected to soar to more than 22 per cent by 2050.
Treasury projections show the effect this will have on costs will be dramatic. Health spending on people older than 65 is expected to increase sevenfold in the 40-year period, while spending on people over 85 will grow 12-fold.
Reining in any of this will be no easy task, not least because health care has won some spectacular victories in the past century.
Death rates from infectious disease, which in 1924 caused 15 per cent of deaths in Australia, fell by 96 per cent to the turn of the millennium. Deaths in infancy and young childhood plunged by 95 per cent, those due to respiratory diseases fell by 80 per cent and various cancers, such as of the stomach, cervix and uterus, fell by 80 per cent to 85 per cent.
Even coronary heart disease - still Australia's biggest killer - is a shadow of its former self. Circulatory diseases peaked in the late 1960s, slaying a little more than 1 per cent of the nation's males a year. By 2000, they killed just 319 for every 100,000 people, or one-third of 1 per cent.
While circulatory diseases still accounted for 46,106 deaths in 2009 - nearly one-third of total deaths that year - they are killing much later in life. The average age of such deaths was 84.7 in 2009.
On the back of these victories, life expectancy has soared. A century ago, rampant illness, violence and injury, as well as rudimentary health care, meant an Australian man would most likely have died before reaching the age when Charles's first hip was replaced.
Life expectancy for men born from 1881 to 1890 was 47.2 years, and 50.8 for women. The vast improvement since then - to 79.3 years for men and 83.9 years for women - is one of our health system's shining achievements.
But this is all on one side of the ledger. The system's success at keeping people alive, plus the many factors connected with changing habits and environment, has wrought radical changes to the nation's health in ways that could scarcely be imagined when the Australian nation was born.
Partly this is driven by the ageing of baby boomers, lighting the fuse for a dramatic increase in the types of conditions that become more prevalent in later life, including cancer and arthritis.
But demographic changes are combining with other factors - such as changed patterns of diet and activity - to foster the rise of chronic, complex conditions that are less likely to kill but require intensive support and treatment.
Life expectancy statistics by themselves tell us little about the quality of life in those extra years.
The regular National Health Surveys conducted by the Australian Bureau of Statistics show the number of people who rate their health as merely fair or poor is falling, from 18.2 per cent in 2001 to 14.9 per cent in 2007-08. But the fair to poor ratings are skewed to older age groups. Other evidence shows the implications of an ageing population: the 2007 Intergenerational Report estimated someone aged 65 to 74 imposed on the taxpayer-funded Pharmaceutical Benefits Scheme more than 20 times the costs generated by someone aged 15 to 24.
"We have got a lot better at looking after people with, say, heart attack than we were doing 20 to 30 years ago, so people survive," says Stephen Leeder, professor of public health and community medicine at the University of Sydney.
As little as 40 years ago - when Leeder was training at Sydney's Royal North Shore Hospital in the late 60s - he and his colleagues "lost a lot of people" who came to hospital after a heart attack.
Now, better drugs, such as the statins that lower cholesterol, prevent many heart attacks in the first place while better treatments have improved recovery.
"What we have done is convert a whole lot of problems that were sudden, explosive and not infrequently lethal into conditions that compromise the quality of life, often drastically so - but nevertheless individuals are alive, but do really require strong support," Leeder says.
"We are getting more older people because people aren't dying younger, but when they don't die younger of something sudden, they die in older age of something that dawdles around for decades.
"And the most frequent circumstance is one where individuals may have five, six, seven, eight, nine conditions. A bit of diabetes, a bit of heart failure, a bit of chest problems and difficulties with their kidneys and eyes not working well, you name it.
"It can be a very confusing jigsaw to try to put together the symptoms of these individuals, for themselves and for those who are looking after them."
The factors at play here - a rising population that is also growing older, higher rates of obesity, rising rates of diabetes and other chronic diseases - can be thought of as a series of converging lines. The closer they get, the more strain the health system feels.
It's a strain that has the politicians going green around the gills.
Former prime minister Kevin Rudd introduced his health reform plans in March last year with the apocalyptic warning that, based on Treasury analysis of figures in the updated Intergenerational Report issued by the government last year, "spending on health and hospitals would consume the entire revenue raised by state governments" by 2045-46.
Australia was already spending $112.8 billion on health in 2008-09, 69.7 per cent of which came from taxpayers. Health has gone from claiming 6.3 per cent of gross domestic product in 1981-82 to 9 per cent in 2008-09.
While chronic disease is not the only driver of this, it is one important factor. And it is one that's starting to show up in other figures.
Data from general practitioners on patient consultations across a decade show fewer patients are seeking help for one condition, while many more appear to have a collection of maladies.
Already, more than half of all GP consultations are for people with heart disease, cancer, neurological illness, mental illness or diabetes, and spending on chronic illness accounts for 70 per cent of total health spending on disease.
Shelf-loads of books are written canvassing what the real issues are facing Australia's health system, and there are certainly those who point to other reasons it is creaking at the joints, such as improving technology and rising patient expectations.
New cancer drugs can cost $50,000 to $100,000 to treat one patient for a year, and governments can come under enormous pressure to fund these even when official bodies have yet to be convinced they are cost-effective. This was the case with Herceptin, which was approved by the Howard government under a special scheme in 2001 for women with late-stage breast cancer.
Newer techniques and treatments can bring big improvements, but there is concern they may also bring marginal improvements for substantial extra cost.
SYDNEY surgeon Mohamed Khadra, 51, has seen the health system from both sides, having been successfully treated for thyroid cancer more than a decade ago. Khadra has written three books, and co-written a play with David Williamson, based on his observations. He believes there has been a rise in the demand for and supply of medical treatment. On one side is "the hypochondriac Australian"; on the other is the doctor ordering batteries of tests to ward off possible lawsuits - all of which bleeds the health budget.
"I think the technology has brought about a belief that we can cure anything," Khadra says. "If somebody dies now, it's almost like you have failed somehow.
"There was a case I was discussing this week: a 90-year-old lady with bladder cancer, which had spread throughout the body. She's demented, in a nursing home, and people are contemplating radiotherapy even though she's bleeding to death, which is actually not a bad way to die. That whole end-of-life decision has changed enormously from 20 years ago."
Khadra describes a love affair between the medical profession and technology that didn't seem to feature 20 years ago.
"It was much more about clinical skills, about being able to smell liver failure on a patient's breath rather than being able to order lots of tests," he says.
"I had a professor of medicine when I was training who used to go around talking about the dollars he was saving the system by being a good clinician. He would say, 'I don't need a CT scan. I can feel this mass and know how big it is, where it is, and that it needs surgery.' "
Khadra also blames rampant bureaucracy and a silo mentality among specialists that leaves no one with overall responsibility for a patient's condition, for the haphazard treatment patients sometimes receive.
"I have a patient at the moment who has something like 14 specialists looking after them," Khadra says. "The part I'm treating is prostate cancer; they have diabetes, a bit of dementia, and they have pressure sores so we have plastic surgeons looking after them.
"It becomes a nightmare. What you require is a general surgeon or general physician to oversee that process. We used to have something called your family doctor. But increasingly people see the family doctor as someone to give them an antibiotic for a chest infection and a referral to see a specialist. A return to family medicine and its values needs to be a matter of urgency in any replanning of the health system."
Regardless of whether the demand is caused by patient expectations or changing disease patterns, objective measures indicate the system is struggling to deliver care to those who need it.
The final report by the National Health and Hospitals Reform Commission, released two years ago this week, found there was a "constellation of problems and service gaps besetting our health care system", including inequities along geographic, socioeconomic, sex and racial lines.
There are many structural problems the NHHRC and others have identified, including cost-shifting between state and federal governments and problems of workforce and striking the right regulatory balance. International comparisons also have found room for improvement.
An 11-nation survey by the US-based Commonwealth Fund found Australians to be the third likeliest, after people in the US and Germany, to avoid some form of health care due to fears of cost. Australians were also third likeliest, after the US and Switzerland, to have to spend $US1000 or more in out-of-pocket costs.
The question all this raises is whether Australia is taking the right steps to adjust its hospitals, GP surgeries and other facilities to cope with changing demographics, behaviour and expectation, and patterns of disease.
There are those who think we are not. Philip Davies, a former deputy secretary in the federal Department of Health and Ageing, and now professor of health systems and policy at the University of Queensland, says it's time to ask if Medicare itself needs a double hip replacement.
Davies says Medicare, the backbone of the health funding system, is "based on a very transactional model of service delivery", particularly with regard to GPs.
"Basically, 30 years ago, if you were sick, you went to see the doctor, who made you better; or maybe you died," Davies says.
"That concept of fee-for-service, where you buy a bit of health care, is thousands of years old. But the problem now is, of course, it's not about curing people, it's about helping people to live with conditions.
"The question then becomes: is that Medicare model appropriate for a health system where ... the balance has shifted towards things that are never going to get cured?"
Earlier this year, Cancer Council Australia chief executive Ian Olver warned the spread of chronic diseases "means previous gains in life expectancy may be reversed. We may see today's teenagers die at a younger age than their parents' generation for the first time in history."
Davies suggests a way to enable health care to cope would be to base services "much more on relationships rather than transactions ... and relationships with a number of different people rather than just with a doctor". He thinks we are having trouble coping with the pressures partly because "we have not questioned the fundamentals about how health care is organised, funded, delivered".
"Are we trying to squeeze a 21st-century pattern of social, epidemiological and financial demands into a 20th-century model of a healthcare system?"
In Khadra's book Terminal Decline, he interviews former Fraser government minister Peter Baume, who is reported as saying governments have raised "expectations that everyone's going to have Rolls-Royce treatment. The reality is we can't afford it."
As Khadra explains, governments have been reluctant to admit to rationing, even though waiting lists and co-payments, the presence of triage nurses in emergency departments and some GP surgeries, and government decisions not to subsidise some treatmentsare all signs it is happening.
The dilemma now is how to streamline for the future and where to allocate resources most effectively, so as to treat the maximum number of patients in a timely fashion, to achieve the best outcomes realistically possible for the lowest reasonable cost.
While Davies and Khadra have their doubts, Leeder thinks the reform measures in train, while not perfect, are a "good beginning".
"What happens now is what we make of it; the structure [of hospital networks and primary care organisations] is probably as good as we are going to get," he says.
Whatever further reforms are introduced, striking a balance between ensuring maximum healthcare provision and preserving the public finances will not be easy.
And the Intergenerational Report shows time will start running out to take the steps to preserve the system's sustainability.
Perhaps a bit like the system that has saved him from a painful retirement, John Charles says he doesn't know "how long I've got" .
Paperwork from Centrelink estimates that, based on population averages, his retirement, starting in November, will last nearly two decades. "Centrelink says I have 18.5 years left, but I'm going to enjoy it, no matter what!"
WHEN Queensland grandfather of five John Charles suffered cramping and seizing in his leg about five years ago, he reckoned he could cope.
When it got worse, making him limp, the warehouse worker who had spent years lifting heavy cartons on to pallets thought he could cope with that, too.
But by the time he was "hobbling to work and hobbling out again", even he was having doubts. Tests showed degeneration of his right hip, which was soon so painful that work became impossible and he would wake up screaming when he rolled over in his sleep.
For previous generations, episodes such as this would have been the downward stepping stones to the loss of independent living. But we - in Australia, at least - live in more fortunate times.
"My GP wrote a letter to Ipswich Hospital and they put me on the waiting list [for a hip replacement]," the 64-year-old recalls.
On April 29 last year, after a worsening of his condition saw him moved up the queue and treated as a private patient at Brisbane's public Princess Alexandra Hospital, Charles, who has not worked since his operations, was fitted with a prosthetic hip.
A year later, on April 28, his left hip was also replaced.
The taxpayer picked up the cost of the devices, estimated to be $12,000 each.
As Charles did not have private health insurance, he estimates the two operations together cost him personally about $10,000, being the fees for the surgeon, anaesthetist and other staff, as well as some tests. "It was worth 10 times that," he says.
"I'm doing a bit of bushwalking again and I'm looking forward to summer, when I can go swimming in the ocean."
Asked what is the most important thing his new hips have allowed him to do again, Charles replies: "I can smile."
After a lifetime of paying taxes, few would begrudge him the surgery that has restored not only his mobility but also his joie de vivre.
Instead, the question this poses is not for individuals but the system: with so many more people entering the age range where operations such as this become common, how will the country afford the care its inhabitants expect?
The growing fear has been that, without reforms, it will not; which raises further questions: Are we doing enough to cope with the pressures? And what useful reforms might we be overlooking?
While the solutions are hard the problem is easy to grasp. It comes down to basic arithmetic, some of which is eye-popping.
The number of Australians aged 65 and older, which was about 14 per cent of the population last year, is expected to soar to more than 22 per cent by 2050.
Treasury projections show the effect this will have on costs will be dramatic. Health spending on people older than 65 is expected to increase sevenfold in the 40-year period, while spending on people over 85 will grow 12-fold.
Reining in any of this will be no easy task, not least because health care has won some spectacular victories in the past century.
Death rates from infectious disease, which in 1924 caused 15 per cent of deaths in Australia, fell by 96 per cent to the turn of the millennium. Deaths in infancy and young childhood plunged by 95 per cent, those due to respiratory diseases fell by 80 per cent and various cancers, such as of the stomach, cervix and uterus, fell by 80 per cent to 85 per cent.
Even coronary heart disease - still Australia's biggest killer - is a shadow of its former self. Circulatory diseases peaked in the late 1960s, slaying a little more than 1 per cent of the nation's males a year. By 2000, they killed just 319 for every 100,000 people, or one-third of 1 per cent.
While circulatory diseases still accounted for 46,106 deaths in 2009 - nearly one-third of total deaths that year - they are killing much later in life. The average age of such deaths was 84.7 in 2009.
On the back of these victories, life expectancy has soared. A century ago, rampant illness, violence and injury, as well as rudimentary health care, meant an Australian man would most likely have died before reaching the age when Charles's first hip was replaced.
Life expectancy for men born from 1881 to 1890 was 47.2 years, and 50.8 for women. The vast improvement since then - to 79.3 years for men and 83.9 years for women - is one of our health system's shining achievements.
But this is all on one side of the ledger. The system's success at keeping people alive, plus the many factors connected with changing habits and environment, has wrought radical changes to the nation's health in ways that could scarcely be imagined when the Australian nation was born.
Partly this is driven by the ageing of baby boomers, lighting the fuse for a dramatic increase in the types of conditions that become more prevalent in later life, including cancer and arthritis.
But demographic changes are combining with other factors - such as changed patterns of diet and activity - to foster the rise of chronic, complex conditions that are less likely to kill but require intensive support and treatment.
Life expectancy statistics by themselves tell us little about the quality of life in those extra years.
The regular National Health Surveys conducted by the Australian Bureau of Statistics show the number of people who rate their health as merely fair or poor is falling, from 18.2 per cent in 2001 to 14.9 per cent in 2007-08. But the fair to poor ratings are skewed to older age groups. Other evidence shows the implications of an ageing population: the 2007 Intergenerational Report estimated someone aged 65 to 74 imposed on the taxpayer-funded Pharmaceutical Benefits Scheme more than 20 times the costs generated by someone aged 15 to 24.
"We have got a lot better at looking after people with, say, heart attack than we were doing 20 to 30 years ago, so people survive," says Stephen Leeder, professor of public health and community medicine at the University of Sydney.
As little as 40 years ago - when Leeder was training at Sydney's Royal North Shore Hospital in the late 60s - he and his colleagues "lost a lot of people" who came to hospital after a heart attack.
Now, better drugs, such as the statins that lower cholesterol, prevent many heart attacks in the first place while better treatments have improved recovery.
"What we have done is convert a whole lot of problems that were sudden, explosive and not infrequently lethal into conditions that compromise the quality of life, often drastically so - but nevertheless individuals are alive, but do really require strong support," Leeder says.
"We are getting more older people because people aren't dying younger, but when they don't die younger of something sudden, they die in older age of something that dawdles around for decades.
"And the most frequent circumstance is one where individuals may have five, six, seven, eight, nine conditions. A bit of diabetes, a bit of heart failure, a bit of chest problems and difficulties with their kidneys and eyes not working well, you name it.
"It can be a very confusing jigsaw to try to put together the symptoms of these individuals, for themselves and for those who are looking after them."
The factors at play here - a rising population that is also growing older, higher rates of obesity, rising rates of diabetes and other chronic diseases - can be thought of as a series of converging lines. The closer they get, the more strain the health system feels.
It's a strain that has the politicians going green around the gills.
Former prime minister Kevin Rudd introduced his health reform plans in March last year with the apocalyptic warning that, based on Treasury analysis of figures in the updated Intergenerational Report issued by the government last year, "spending on health and hospitals would consume the entire revenue raised by state governments" by 2045-46.
Australia was already spending $112.8 billion on health in 2008-09, 69.7 per cent of which came from taxpayers. Health has gone from claiming 6.3 per cent of gross domestic product in 1981-82 to 9 per cent in 2008-09.
While chronic disease is not the only driver of this, it is one important factor. And it is one that's starting to show up in other figures.
Data from general practitioners on patient consultations across a decade show fewer patients are seeking help for one condition, while many more appear to have a collection of maladies.
Already, more than half of all GP consultations are for people with heart disease, cancer, neurological illness, mental illness or diabetes, and spending on chronic illness accounts for 70 per cent of total health spending on disease.
Shelf-loads of books are written canvassing what the real issues are facing Australia's health system, and there are certainly those who point to other reasons it is creaking at the joints, such as improving technology and rising patient expectations.
New cancer drugs can cost $50,000 to $100,000 to treat one patient for a year, and governments can come under enormous pressure to fund these even when official bodies have yet to be convinced they are cost-effective. This was the case with Herceptin, which was approved by the Howard government under a special scheme in 2001 for women with late-stage breast cancer.
Newer techniques and treatments can bring big improvements, but there is concern they may also bring marginal improvements for substantial extra cost.
SYDNEY surgeon Mohamed Khadra, 51, has seen the health system from both sides, having been successfully treated for thyroid cancer more than a decade ago. Khadra has written three books, and co-written a play with David Williamson, based on his observations. He believes there has been a rise in the demand for and supply of medical treatment. On one side is "the hypochondriac Australian"; on the other is the doctor ordering batteries of tests to ward off possible lawsuits - all of which bleeds the health budget.
"I think the technology has brought about a belief that we can cure anything," Khadra says. "If somebody dies now, it's almost like you have failed somehow.
"There was a case I was discussing this week: a 90-year-old lady with bladder cancer, which had spread throughout the body. She's demented, in a nursing home, and people are contemplating radiotherapy even though she's bleeding to death, which is actually not a bad way to die. That whole end-of-life decision has changed enormously from 20 years ago."
Khadra describes a love affair between the medical profession and technology that didn't seem to feature 20 years ago.
"It was much more about clinical skills, about being able to smell liver failure on a patient's breath rather than being able to order lots of tests," he says.
"I had a professor of medicine when I was training who used to go around talking about the dollars he was saving the system by being a good clinician. He would say, 'I don't need a CT scan. I can feel this mass and know how big it is, where it is, and that it needs surgery.' "
Khadra also blames rampant bureaucracy and a silo mentality among specialists that leaves no one with overall responsibility for a patient's condition, for the haphazard treatment patients sometimes receive.
"I have a patient at the moment who has something like 14 specialists looking after them," Khadra says. "The part I'm treating is prostate cancer; they have diabetes, a bit of dementia, and they have pressure sores so we have plastic surgeons looking after them.
"It becomes a nightmare. What you require is a general surgeon or general physician to oversee that process. We used to have something called your family doctor. But increasingly people see the family doctor as someone to give them an antibiotic for a chest infection and a referral to see a specialist. A return to family medicine and its values needs to be a matter of urgency in any replanning of the health system."
Regardless of whether the demand is caused by patient expectations or changing disease patterns, objective measures indicate the system is struggling to deliver care to those who need it.
The final report by the National Health and Hospitals Reform Commission, released two years ago this week, found there was a "constellation of problems and service gaps besetting our health care system", including inequities along geographic, socioeconomic, sex and racial lines.
There are many structural problems the NHHRC and others have identified, including cost-shifting between state and federal governments and problems of workforce and striking the right regulatory balance. International comparisons also have found room for improvement.
An 11-nation survey by the US-based Commonwealth Fund found Australians to be the third likeliest, after people in the US and Germany, to avoid some form of health care due to fears of cost. Australians were also third likeliest, after the US and Switzerland, to have to spend $US1000 or more in out-of-pocket costs.
The question all this raises is whether Australia is taking the right steps to adjust its hospitals, GP surgeries and other facilities to cope with changing demographics, behaviour and expectation, and patterns of disease.
There are those who think we are not. Philip Davies, a former deputy secretary in the federal Department of Health and Ageing, and now professor of health systems and policy at the University of Queensland, says it's time to ask if Medicare itself needs a double hip replacement.
Davies says Medicare, the backbone of the health funding system, is "based on a very transactional model of service delivery", particularly with regard to GPs.
"Basically, 30 years ago, if you were sick, you went to see the doctor, who made you better; or maybe you died," Davies says.
"That concept of fee-for-service, where you buy a bit of health care, is thousands of years old. But the problem now is, of course, it's not about curing people, it's about helping people to live with conditions.
"The question then becomes: is that Medicare model appropriate for a health system where ... the balance has shifted towards things that are never going to get cured?"
Earlier this year, Cancer Council Australia chief executive Ian Olver warned the spread of chronic diseases "means previous gains in life expectancy may be reversed. We may see today's teenagers die at a younger age than their parents' generation for the first time in history."
Davies suggests a way to enable health care to cope would be to base services "much more on relationships rather than transactions ... and relationships with a number of different people rather than just with a doctor". He thinks we are having trouble coping with the pressures partly because "we have not questioned the fundamentals about how health care is organised, funded, delivered".
"Are we trying to squeeze a 21st-century pattern of social, epidemiological and financial demands into a 20th-century model of a healthcare system?"
In Khadra's book Terminal Decline, he interviews former Fraser government minister Peter Baume, who is reported as saying governments have raised "expectations that everyone's going to have Rolls-Royce treatment. The reality is we can't afford it."
As Khadra explains, governments have been reluctant to admit to rationing, even though waiting lists and co-payments, the presence of triage nurses in emergency departments and some GP surgeries, and government decisions not to subsidise some treatmentsare all signs it is happening.
The dilemma now is how to streamline for the future and where to allocate resources most effectively, so as to treat the maximum number of patients in a timely fashion, to achieve the best outcomes realistically possible for the lowest reasonable cost.
While Davies and Khadra have their doubts, Leeder thinks the reform measures in train, while not perfect, are a "good beginning".
"What happens now is what we make of it; the structure [of hospital networks and primary care organisations] is probably as good as we are going to get," he says.
Whatever further reforms are introduced, striking a balance between ensuring maximum healthcare provision and preserving the public finances will not be easy.
And the Intergenerational Report shows time will start running out to take the steps to preserve the system's sustainability.
Perhaps a bit like the system that has saved him from a painful retirement, John Charles says he doesn't know "how long I've got" .
Paperwork from Centrelink estimates that, based on population averages, his retirement, starting in November, will last nearly two decades. "Centrelink says I have 18.5 years left, but I'm going to enjoy it, no matter what!"
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