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Author: Arthur Chesterfield-Evans

15/11/2020

Aged care: What is the prognosis? 15/11/20

I attended a DRS (Doctors Reform Society) zoom webinar on the future of health care with Professor Stephen Duckett and aged care with Professor Joseph Ibrahim of Monash Uni, a geriatrician whose experience is in evidence-based aged care.

It was not encouraging.

Preamble:

My own experience of nursing homes was initially as an after-hours doctor when I used to judge nursing homes by what I turned the Urine Smell Index; the worst ones smelled of urine when you opened the door at night. As a GP years ago I found it increasingly difficult to find someone trained to talk to about the patients’ treatments.

In New South Wales Parliament as an MP I was asked to pass legislation that lessened the number of trained nurses required on staff. ‘Flexibility’ was the key and many homes and facilities ‘had people who were not really sick’ we were told. I was not convinced but the legislation went through anyway.

When my widowed mother was no longer able to cope at home and the family went looking for supported accommodation it soon became clear that the driving force in Aged Care is real estate profits. The family home is sold and the object is to get the family to buy an overpriced retirement Villa with varying levels of support in the villa and then hopefully automatic entry into an attached nursing home, usually with quite a poor urine smell index. When the old person dies the villa profit largely reverts to the corporation.

A dear old widower professor who lived up the road needed support in his 90s. The home support contract offered needed at least 4 hours per week at $65 per hour. The person delivering the care was paid $20 an hour. I am unsure how District Nurses are allocated.

In 2000 Prime Minister Rudd asked for ideas for his ‘2020 Vision’. I wrote and suggested that he register the skills and training of Home Care workers so that they could be hired and evaluated like Uber of any other online service and the ‘quality control and insurance’ would not be why the contracting agency became so ‘vital and expensive’ (that it would end up costing more than the person who actually did the work). I never even had an acknowledgement of my suggestion.

Prof Duckett was of the opinion that things had got a lot worse since the 1997 Aged Care Act, John Howard’s work, which created ‘a business opportunity’ Prior to this there was a system called CAMSAM which was two modules; Care Aggregated Module and Standard Aggregated Module. These were funded separately. If they did not spend their Care money it was forfeited, so they could only profit on Services.

After 1997 there was no distinction so profits could be made from either component, so the quality of care declined, usually with lower staffing levels.

Some private-for-profit nursing homes have good care, but this is not common. Some not-for-profits also had very poor care, but the general rule is that the standard of care relates to the number and training of staff. The low wages (approximately equals $20 per hour) mean that the staff need to work multiple jobs in multiple locations which is what spread the COVID epidemic in Melbourne. Government run homes tended to have better staffing ratios, so were better able to act against the infection.

Professor Joseph Ibrahim commented that the terms of reference of the current Royal Commission on Aged Care were very narrow, only covering 5 years, and could not lead to prosecution. He felt that this was deliberate. The issues of overprescribing and assault have come up often.

He felt that this meant that it’s conclusions might be weaker and then not implemented, with a tendency to kick difficult problems down the road.

The commissioners themselves were of interest:

Richard Tracey had died before the enquiry started

Another, a Western Australian prosecutor had opted out (an unusual action as being on a Royal Commission is normally a good career move).

The two final commissioners are:

Tony Pagoni, Chairman- a retired judge who had had a specialisation in tax law and
Lynette Briggs- a career health bureaucrat

Commissioner, Briggs has put out a report asking that aged care be returned to the control of the health department. Prof Ibrahim comments that is very unusual for one Commissioner to make a public statement before the final report and this indicates that the commissioners are not in agreement.

Currently there are about 250,000 care workers and about 200,000 Professionals. The care workers need six weeks training at a TAFE level to get a ‘Certificate 3’ About 1/3 are new migrants. They are paid about $20 per hour and casualised to decrease staff costs. The unions are worried that the new RECP (Regional Comprehensive Economic Partnership) trade treaty actually allows trade in people and that more visas for cheap labour in these areas will not help residents or local jobs.

The $20 billion dollar industry is founded approximately $14.5 billion from government, $4 billion from RADS and $2-4 billion for additional services.

There are not-for-profits, but the large for-profit providers have increased since the 1977 act and are largely highly profitable big corporations, some multinational like BUPA.

Professor Ibrahim is concerned that there is a lack of supervision.

There are no forensic accountants looking at what it costs to run an aged care facility and this has allowed supernormal profits by big players. Money has been spent poorly or ‘hived off’. Obviously if the government runs some homes themselves there will be public service experience.

Prof Ibrahim believes that the future directions of aged care will be set by the multinational for-profit providers because these are the people who have direct access to the government. There is no significant advocacy for aged care residents. He contrasts this with breast cancer advocates who pressed for less radical operations, and for Gay men who pressed for more enlightened AIDS/HIV policies.

There have been discussions of ‘quality-of-life’ that have tended to be spoken of as needing less healthcare, but quality of life cannot be good without good health care.

The aged care industry likes home care as it lessens their costs and also pushes the liability back onto GPs. A sense of proportion is necessary:

There are 2.5 million well older people and 200,000 in aged care.

More radical treatments are now done in older age groups such as dialysis or cardiac surgery in the over 90s, very is some debate over this period some would say that it is a just to deny routine treatments but there is some distortion of priorities by having these lucrative procedures as fee-for-service, and there is also some inequity.

Since the development of antibiotics, medicines are seen as curative, but in fact they should be seen as being in three classes:

1. Curative

2. Palliative

3. Preventative

There is quite a lot of cost-ineffective medication use, such as for osteoporosis.

Solutions. (These are not just from the presenters)

A national registration system for all levels of care workers period this should include people who do home help with shopping cleaning and gardening as well as Medical & personal care workers.
Existing TAFE courses should be recognised but more courses will be needed.
There needs to be a feedback database for complaints/praises and ratings as there is for AirBNB, restaurants etc. The feedback database needs to be actively monitored by the regulator to follow up complaints or untoward events.
There needs to be a regulation system with accreditation and regular random inspections of facilities and surveys of residence.
Academic researchers such as AIHW (Aust. Institute of Health and Welfare) should be at arm’s length and should have long-term commissions to do longitudinal studies of aged welfare and satisfaction so that individuals cannot be targeted if they state that they are not happy with the care in their institutions.
This should be combined with health research.
There should be formal structured feedback systems with residents’ groups having paid advocacy groups and formal places and rights on regulatory bodies.
There must be minimum wages and conditions for all workers and minimum staffing standards.
The Regulatory body must have a policing function, supervising staffing and wage levels and food and care standards

Final Comment

Note there are a large number of public submissions on the Royal Commission website, many of which make discouraging reading. The privatisation seems to have led to profit-seeking rather than an improvement in care, and the political forces seem likely to continue this.

http://agedcare.royalcommission.gov.au

11/11/2020

Medicine, Reality and the US vote 11/11/20

Doctors tend to assume that everyone knows certain things, particularly because everyone they meet usually does. They also tend to think that everyone knows the order of importance of what they know.

Many years ago as I started to campaign against tobacco, Henry Mayer, the first Professor of Political Economy in Sydney, who had a regular column in the SMH told me that the health people were invisible in the media on the tobacco issue. I said that this was ridiculous, it was the most studied subject in the history of medicine, with over 60,000 papers and growing daily. He pointed to a person called Tollison, who wrote in the non-medical media that was read by the business sector. There were no medical responses there. The mainstream also media had relatively little on tobacco, as tobacco advertising was one of the major sources of revenue.

So the harm of tobacco was known, but ignored, like the fact that you are going to die one day.

It came home to me, when I amputated the leg of a smoker for vascular disease. He had bad lungs and a bad heart. I said, ‘Look mate, if you keep smoking, you will lose the other leg.’

To my amazement he replied, ‘Look, all you doctors go on about smoking, but if it was as bad as you say it is, the government would do something about it’.

He had internalised the government’s non-action as being mute testimony to it not being a problem. Doctors are, after all a subculture that claims to have expertise in a certain area, as do engineers, educators, weather forecasters and many other groups. In tobacco, the Tobacco Industry, the Australian Hotels Association, Clubs and Pubs and the advertisers and sponsorship recipients fought like tigers to stop reasonable public health policy. They are probably still retarding it- there has not been a Quit campaign in Australia for over a decade.

Trump’s denial of the significance of COVID19 must have struck a chord with those who knew that in the absence of decent welfare system a lockdown would send them broke. They needed to believe that they could carry on, and he and his denial were their salvation. A lot of business interests supported them- they would go broke too.

So it was interesting that the health facts became politicised, and wearing a mask was as much a political statement as a medical one. Politics was not, and will not be in future a good basis for personal preventive heath decisions. So controlling the COVID epidemic in the US will be harder than here, where mainly apathy and complacency are in the way.

The figures that only 4% of people in the US changed their view on the dangers of COVID goes some way to explaining why Biden did not have a landslide. For many people, COVID was not an issue, Trump’s rhetoric was plausible if you did not fact-check, and the economy had been going OK prior to the epidemic.

SMH today:

Virus neglect didn’t infect Trump vote

Shaun Ratcliff

Since the first person was diagnosed with COVID-19 in the US, more than 10 million cases have been confirmed and nearly a quarter of a million people with the virus have died.

Watching from afar, in a country where the coronavirus has been significantly less lethal, it is surprising the incumbent president did as well as he did.

While the pandemic probably did cost him votes, surveys we have run over the course of the year showed there are strong partisan effects on attitudes towards COVID-19, with supporters of Donald Trump mostly unconcerned about the risks from the virus, and getting less worried as the year went on.

These surveys were run in May and September. Both surveys consisted of responses from more than 1000 Americans.

In May, approximately 40 per cent of all Americans were very or extremely worried about the possibility they or a family member might catch the virus. Almost the exact same number were only a little or not at all worried. According to our data, this level of concern actually declined slightly between May and September.

This was largely a partisan affair. Respondents who said they were going to vote for Joe Biden retained a similar level of concern during this period, with 48 per cent very or extremely worried in May, and 50 per cent in September.

However, respondents who said they would vote for Trump were not very concerned about COVID-19 in May – about 19 per cent reported they were worried about it in the first survey and just 11 per cent of Trump voters reported this level of concern in the second survey.

The partisan differences, and the declining trend in Republican concern about COVID-19, are largely the product of the extremely polarised media and political environment in the US.

Trump voters are less trusting of information on COVID-19 from medical experts than Biden supporters, and between May and September a quarter of Republican voters became less likely to trust information from these experts.

This difference may, in part, stem from the media through which they obtain information. Those with the lowest levels of trust tended to rely upon more conservative cable and online news like Breitbart and Fox News, for instance, which have played down the risk posed by the pandemic.

Republicans who rely more on these conservative media outlets were more likely to have lower levels of trust in medical experts, even after controlling for demographic differences between Democrats and Republicans. They were also as likely to trust Donald Trump as medical experts for information on the coronavirus.

In this polarised environment, very few voters abandoned Trump between May and September (only about 4 per cent in our data), and hardly any shifted to support Biden.

Trump supporters tended to align their position on the coronavirus with their political allegiance. Relying more on media that downplayed the significance of the coronavirus, and taking cues from Republican leaders, they decided the pandemic was not a significant threat.

Our data indicates Biden was able to win over a small number of voters who supported neither candidate at the start of the year. It was enough to win in the end, but not enough to deliver the predicted landslide.

Shaun Ratcliff is a lecturer in political science at the United States Study Centre, University of Sydney.

09/11/2020

Biden Wins, but is America Trumped? 9/11/20

Biden won the US election, but everyone was surprised how close it was and how well Trump did.

It might be said that had there not be the COVID19 virus and Trumps handling it very badly, he probably would have won. Many have been wringing their hands for years, but whatever lies he tells, however much fact-checking was done, Trump seemed Teflon-coated. The standards have changed. Did we really think politicians had to tell the truth in the past and have them resign if they were caught out? The reality show host told people that economy was doing well, the stock market was up and the COVID would disappear and if he wasn’t consistent with yesterday, that is for fact-check researchers. He is still the same friendly face and reassuring voice for many.

But at a more fundamental level, the middle class in the US have been having a bad time for a long time. Neo-liberal economics favours world trade, China does it cheaper and jobs are offshored. The importers can pay Chinese prices for goods, and charge US prices, so their margins have gone up. In 2008 Obama’s slogan was that ‘Change is Possible’ but he failed to capitalise on Democrat control of the Senate and when the Global Financial Crisis came, he bailed out the banks, not the little people who still lost their homes. In 2016 Bernie Sanders recognised the problem, but the Democrat Establishment were scared of him, suppressed the vote in the Primaries and put in Hilary Clinton. Hilary Clinton, as ex-First Lady and Secretary of State was seen as part of the Establishment, and hence part of the problem.

Trump played this, as well as the voting system that favoured small states with Republican governments who wrote the electoral laws with varying degrees of voter suppression. Trump remained Anti-Establishment man, a populist, who would say anything to be popular. This time again, Sanders spoke of the need for change and used the word ‘Socialist’, a brave thing to do in America. The Democrat Establishment was again scared, and again used some voter suppression and getting the other less successful moderate candidates to withdraw to allow Biden’s late run for the Democrat nomination. So the people who wanted change were dudded again. The Democrats had an Establishment candidate, and the Republicans ran a candidate who pretended to be for the battlers.

The current situation is portrayed as just Trump’s ego stopping Biden getting on with the job, but that does not explain why 70 million people still voted for Trump and are very angry. Poorer Americans have a lot to be upset about. Biden was considered ‘past it’ by both the common people and the Democrat Establishment until the younger candidates were failing against Sanders. Biden was suddenly wheeled in to both save the poor people and get the big end of town’s money.

The Democrats scraped in this time. But this does not make Biden a good candidate. It is by no means certain that Biden has any idea how to fix the problem, or if he would be allowed to fix it if he did. Conservative Democrats put him there, and he is likely to have a Republican majority in the Senate, which neither wants progressive change, nor wants to help Biden at all. So enjoy the fine rhetoric while you can.

Even in defeat Trump will have enough power within the Republican party to destroy the pre-selection chances of any Republican who upsets him, so he may continue strutting around making up realities, with an overall effect like a bull in a china shop. But Trump in a strange sort of way was a beacon of hope, who recognised the discontent and tapped it. Though he did little to improve the situation, he gave hope that the Establishment could be defied and this role may continue.

The crunch time will come soon, when the disillusioned voters realise the situation. Will there be a systematic response, marches or vandalism? Time will tell.

It is accepted that the US voting system is so rigged that there is little chance for any candidate not backed by huge amount of money, and the system is hugely rigged in favour of the small states which favours the Republicans. The question is whether the voting system can be fixed for next time- it is hard to see how. It is stuck in the Constitution. The welfare system, the health system, the education system, the wages system and the competitiveness of American industry all seem very complex, with their solutions in different sectors of the economy. Biden is better than Trump, but that was a very low bar.

09/11/2020

US Election Commentary- Warning- long post, innovative stuff nearer the end 5/11/20

I shudder to comment on the US Elections- it is a crowded field- 15 professional commentators in today’s SMH alone, and that is without the electronic ones.

But I had a few thoughts, firstly about the US Voting system which is very flawed, then about the candidates, and finally about what might happen:

Biden looks likely to win and Trump is dangerously stoking tensions by calling into question the integrity of the whole US electoral system. The US electoral system is probably not corrupt in a limited meaning of the term. The mail ballots are sent in, and should be counted and not be fraudulent. The counting process is well supervised and credible.

But the whole system is hopelessly outmoded and non-democratic. Here are a few issues:

The candidate who wins the popular votes does not necessarily win the Presidency because of the Electoral Colleges system.

The Electoral College system gives two votes to every state, but it was set up when the US Constitution was written, so States with few people have far more votes College vote per citizen that populous States. So Wisconsin has 1 Electoral College vote for every 195,000 voters whereas California has one electoral college vote for every 670,000 voters, a ratio of nearly 3.5:1. The small States are mostly Republican and in the centre of the country and there are more of them.

In most States, whoever wins the State gets all the Electoral College votes, so if a lot of small states are won, this gives the Republicans a big advantage, which is why Bush Jnr and Trump won with a minority of the popular votes. If Trump wins this time, it will again be with a minority of popular votes.

This problem is hard to fix as it is in the Constitution, and the small states, like Tasmania in Australia will resist this and there are about 30 Tasmanias in the USA.

Voter suppression is another art practised particularly in Republican states. This involves changing the rules so that certain groups are less likely to be able to vote. If for example, people who have been in gaol are ruled ineligible to vote, it disadvantages black voters. If the proof of address is needed, poorer people whose voter registration records are less up to date are more likely to be ruled ineligible. If there are few ballot boxes in certain areas and they are hard to get to, etc. It is almost certain that the actions of Governor Bush in Florida, the Presidential candidate’s brother helped George W Bush by suppressing voters and gave him the Presidency over Al Gore. You may recall that there was an appeal to the Supreme Court for a recount and this was denied, the Supreme Court members voting in the interest of the Party that appointed them. This is why Trump keeps talking about appealing to the Courts.

There is also ‘first past the post’ voting rather than preferential, which means that any third candidate merely takes votes from the candidate closest to him or her, and this may favour someone with less than a majority.

The gerrymander of the electoral boundaries is another problem in the US. The incumbents set boundaries that wander in strange shapes to take in pockets of voters and allow an incumbent to survive while the adjacent electorates have huge majorities for the other party, and if there was a fair redistribution the seats would all go the other way.

There is no Federal equivalent of the Australian Electoral Commission, which puts out a model for fair electoral boundaries and then hears representations of why they should be changed from this. Rather, in the US there is a different electoral system in each state, because that was necessary to get the States to form the United States. It was not that the founding fathers thought that this was the best system- it was simply the best that they could do under the circumstances. So it will be very difficult to fix.

At a practical level, Trump seems willing to divide the country. He would probably have won had there not been a COVID epidemic. There were more jobs and the stockmarket was high. Generally if the economy is doing well, incumbents are re-elected other issues notwithstanding. Trump was seen to have mismanaged the COVID epidemic, playing it down as tens of thousands died and millions were infected. How anyone can still think it is a hoax is difficult to understand, (but this article is not about the media). How much a President can actually do is other question. Administration at a day to day level is by States, as we have found in Australia in the epidemic, they still have quite a lot of power. It will be interesting to see how much Biden can do if he wins. At least he is likely to recognise the seriousness, state it clearly and mobilise resources.

It seems as the votes are counted that Biden will win but partly due to some of the factors above by a lesser margin than was expected. The longer the count goes on, the more Trump will stir trouble, and there may be riots as his supporters are strengthened in the idea that he was robbed. It is significant that all the shops are boarded up in the most fashionable streets in Washington DC. This is not some backwater- these streets are the equivalent of the most expensive areas in Sydney CBD.

The question will be asked, how could Trump do so well after such dishonesty and incompetence. I will try to get in early on this. Trump did some good in foreign policy. He probably stopped the US attacking Iran, and did not commit the US in Syria, which allowed Assad and the Russians to win, but it was hard to see a good outcome whatever happened and it may have been another US quagmire. He has ‘stood up to China’ economically and militarily, made peace overtures to North Korea, persuaded some Arab states to recognise Israel, torn up the NAFTA (North America Free Trade Agreement0 with Canada and Mexico, and taken a far more nationalistic line on trade. Whether all these are good remains to be seen, but they do constitute policy change that is broadly popular with his constituency.

In his style he has tweeted- a direct communication to the common person. This is the antithesis of what was done before. Hilary Clinton was seen as a child of the Establishment, the bankers who had been bailed out in the GFC when a lot of people lost their homes. Presumably if they had been given the money they would have given it to the banks and they would have survived as well as the banks, but perhaps that was too administratively difficult. Jobs have gone offshore because labour is cheaper there, which has hollowed out the middle class, particularly in the manufacturing sector. Though this may have been forgotten by the media it is not forgotten by those affected, who do not trust the Establishment, which is partly why conspiracy theories and populism can flourish.

Just looking at the Campaign hoopla: Trump was exciting and optimistic, Biden looked the Conservative, unexciting with a negative message. The Establishment had not fixed the problems before, now it was demanding its place at the head again to have another go. Trump may have been talking fantasy, but it was hopeful fantasy, and reality does not look so bright. It is like a religious cult; if you assess it with your heart, it seems right, if you use your head it does not. It is as if many people in Western society are choosing pleasant fantasy over unpleasant reality with Trump and Biden personifying the choice.

I spoke to Joe Laurie of Consortium News during the week before the election. He had an interesting story about Biden that is probably true. No one thinks that Biden is a very good candidate. Most of us thought that he was past it, and I asked some weeks ago what the minimum criterion for a President was; to read an autocue? It seems that the Democrat Establishment were not too impressed by Biden but there was a shortage of a credible moderate candidate. They were scared of Bernie Sanders. He represented a major change. He admitted to wanting things that had been termed ‘socialist’ like universal health care, bigger taxes and more welfare. Elisabeth Warren was the next most progressive. There were a number of moderate candidates, Pete Buttigieg, Amy Lobucher, Tulsi Gabband, and the immensely wealthy Michael Bloomberg. The Democrat Establishment let them have a run, but Sanders was beating them all. So somewhat belatedly the Democrat Establishment tapped all the young moderates on the shoulder, told that that they could not win, and asked then to stand aside and let it be Biden v Sanders. Elizabeth Warren was left there, as she was more likely to take votes from Sanders, and it made it look like a more open race. The Democrat Establishment then supported Biden as much as possible, including doing some voter suppression in the Primaries in California in areas where Sanders was strong. Sanders was robbed in 2016, and probably again. So the Democrat Establishment, which represents much of the business world got an acceptable if not optimal candidate, Biden.

The people who had lost their jobs in the GFC and did not trust Hilary Clinton and were not much more impressed with Biden, who was after all, as much of a creature of the status quo as she was. So if you ignore COVID, and do not care much what else Trump has said, apart from noting that he has upset the Establishment, you get some idea of why his vote has held up so much better than was expected.

The psephologists say that the polls are wrong, partly because of the complexity of the voting systems, but also because people do not admit that they are voting for Trump. They tell the pollsters one thing, and vote another. Perhaps political correctness influences their polling behaviour.

But if Biden wins, what can he do? He is very much part of the Establishment, who rejected Sanders’ solutions. The world market takes jobs to where labour is cheapest, particular if it is well organised, like in China. An unregulated market is like a Monopoly game. Those with more money set the prices and the rents, and those at the bottom compete with each other as price takers. So money flows upward; the rich get richer, and the poorer people recognise this. Governments have to act with wages that share the wealth, welfare that provide services and universal things like parks and roads, health and education. If governments are not willing to do this, and the welfare is to the top end as it was in the GFC people do not trust the system. Is Biden the man to fix this? I doubt it.

Marx looked at history from an economic perspective and said that revolution would come in an advanced capitalist society basically because the wealth would increasingly be concentrated in fewer and fewer people. He did not glorify revolution (as many have since), he merely said that it would become necessary because the rich would not give up their money without a fight. The US rioters have been called opportunists and looters, but also the bogeyman of the socialist revolution has been discussed. All this may seem premature or logistically impossible, but if the economic drivers remain in the same direction, it is certainly a matter of concern. The Establishment must recognise that the economic system cannot remain as it is. A Republican Senate with Biden as President does not bode well, particularly if Trump’s swansong is to focus many people’s frustration.

I attach Consortium News’ article on Voter Suppression

WATCH: CN Live! New Episode—‘Voter Suppression’ With Greg Palast

15/10/2020

Gladys Has to Go 15/10/20.

I feel somewhat sorry for Gladys Berejeklian. She is an intelligent woman who was born in Sydney in an Armenian family and according to Wikipedia did not learn English until she was 5. Raised in Australia and reasonably intelligent, she was not married by the age of 24, which is often expected in a traditional Armenian community. So she would have had a lot of pressure to succeed in politics. To do this she had to please the men with power in the Liberal Party and its donors.

She may have been honest, but as Shadow Transport Minister she initiated the light rail project and then was responsible for it and the underground freeway project. The cost of the light rail project blew out and the tunnels have gone from $10 to $18 billion. Sydney is the last city in the world to be building underground freeways, and the opportunity cost is that we will now not have a decent metro network but the Roads lobby was stronger than the Rail lobby, so this outcome can be understood in a compliant political context. Gladys is hard-working and took advice during the bushfires and COVID19 crisis, but it seems she was vulnerable to Darryl Maguire, the undistinguished ex-member for Wagga Wagga who is now before ICAC.

If it is true that she told him not to tell her things that he was doing and she saw developers that the relevant Minister refused to see for him, she is in trouble. It is also alleged that Maguire asked her as Treasurer to see people who wanted to build the Wagga Wagga by-pass, which the Roads Dept. thought was not a cost-effective option, and such was actually built. Building roads favours the builders, but also changes the land value hugely, so some developers stand to make a fortune. Maguire was in ICAC today and part of the hearing was in camera, so the situation is not yet clear.

As a person interested in the appalling job that iCare has done, and aware of the venality of its management and the fact that it paid for two US political advisers in Treasurer Perottet’s office, I wondered why there was no suggestion that he should resign. A letter in yesterday’s’ SMH suggested that perhaps with Gladys’ personal situation as it is she was in no position to challenge Perottet. We might remember that an honest man, Premier Barry O’Farrell, resigned for not remembering that he had never received a bottle of wine from a dodgy developer and being goaded into saying so as an unequivocal statement. Standards have gone down a long way since then.

Gladys should go, so should Perottet, but sadly neither the NSW Liberals nor the Labor Party are replete with talent to replace them.

www.smh.com.au/national/nsw/glass-of-red-was-a-code-daryl-maguire-contradicts-of-former-minister-s-chief-of-staff-20201014-p5651q.html

11/10/2020

Marketing Obesity to Children 11/10/20

About 37 years ago BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions) identified the problem of advertisers marketing to children and produced a guide, ‘AdExpo- A Self-Defence Course for Children’. It was in black and white as BUGA UP had no money and the ads are a bit dated now, but the text us still relevant. www.bugaup.org/publications/Ad_Expo.pdf

Advertisers market to children, and are successful with it. Now there is the internet, which has made things a lot worse. Kids can be targeted with the parents only dimly aware of what is going on, and before the kids have actually been formally ‘taught’ anything. The ads are part of the exciting environment that their little heroes show them. At last attention is being drawn to this. This article is from the NY Times, with a cut-down version in the SMH of 7-8/11/20.

Are ‘Kidfluencers’ Making Our Kids Fat?

By Anahad O’Connor, NY Times 30/10/20

Popular YouTube channels often bombard young children with thinly veiled ads for junk food, a new study finds.

One of the most popular YouTube videos from Ryan’s World shows its star, Ryan Kaji, pretending to be a cashier at McDonald’s. “It’s a stealthy and powerful way of getting these unhealthy products in front of kids’ eyeballs,” a public health expert says.Credit…via YouTube

That is the conclusion of a new study published on Monday in the journal Pediatrics. The authors of the study analyzed over 400 YouTube videos featuring so-called kid influencers — children with large social media followings who star in videos that show them excitedly reviewing toys, unwrapping presents and playing games. The study found that videos in this genre, which attract millions of young followers and rack up billions of views, were awash in endorsements and product placements for brands like McDonald’s, Carl’s Jr., Hershey’s, Chuck E. Cheese and Taco Bell.

About 90 percent of the foods featured in the YouTube videos were unhealthy items like milkshakes, French fries, soft drinks and cheeseburgers emblazoned with fast food logos. The researchers said their findings were concerning because YouTube is a popular destination for toddlers and adolescents. Roughly 80 percent of parents with children 11 years old or younger say they let their children watch YouTube, and 35 percent say their children watch it regularly.

A spokeswoman for YouTube, citing the age requirement on its terms of service, said the company has “invested significantly in the creation of the YouTube Kids app, a destination made specifically for kids to explore their imagination and curiosity on a range of topics, such as healthy habits.” She added, “We don’t allow paid promotional content on YouTube Kids and have clear guidelines which restrict categories like food and beverage from advertising on the app.”

Young children are particularly susceptible to marketing. Studies show that children are unable to distinguish between commercials and cartoons until they are 8 or 9 years old, and they are more likely to prefer unhealthy foods and beverages after seeing advertisements for them.

Experts say it is not just an advertising issue but a public health concern. Childhood obesity rates have skyrocketed in recent years: Nearly 20 percent of American children between the ages of 2 and 19 are obese, up from 5.5 percent in the mid 1970s. Studies have found strong links between junk food marketing and childhood obesity, and experts say that children are now at even greater risk during a pandemic that has led to school closures, lockdowns and increased screen time and sedentary behavior. The new findings suggest that parents should be especially wary of how children are being targeted by food companies on social media.

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“The way these branded products are integrated in everyday life in these videos is pretty creative and unbelievable,” said Marie Bragg, an author of the study and an assistant professor of public health and nutrition at the New York University School of Global Public Health. “It’s a stealthy and powerful way of getting these unhealthy products in front of kids’ eyeballs.”

Dr. Bragg was prompted to study the phenomenon after one of her co-authors, Amaal Alruwaily, noticed her young nieces and nephews obsessively watching YouTube videos of “kidfluencers” like Ryan Kaji, the 9-year-old star of Ryan’s World, a YouTube channel with 27 million subscribers, formerly named Ryan ToysReview.

The channel, run by Ryan’s parents, features thousands of videos of him excitedly reviewing new toys and games, doing science experiments and going on fun trips to stores and arcades.

Children’s channels like Ryan’s World — which are frequently paid to promote a wide range of products, including toys, video games and food — are among the highest grossing channels on YouTube, raking in millions of dollars from ads, sponsored content, endorsements and more. According to Forbes, Ryan earned $26 million last year, making him the top YouTube earner of 2019. Among the brands he has been paid to promote are Chuck E. Cheese, Walmart, Hasbro, Lunchables and Hardee’s and Carl’s Jr., the fast food chains. One of his most popular videos shows him pretending to be a cashier at McDonald’s. In it, he wears a hat with the McDonald’s logo, serves plastic Chicken McNuggets, cheeseburgers and French fries to one of his toys, and then eats a McDonald’s Happy Meal. The video has been viewed about 95 million times.

“It looks like a normal child playing with their normal games, but as a researcher who studies childhood obesity, the branded products really stood out to me,” Dr. Bragg said. “When you watch these videos and the kids are pretending to bake things in the kitchen or unwrapping presents, it looks relatable. But really it’s just an incredibly diverse landscape of promotion for these unhealthy products

In a statement, Sunlight Entertainment, the production company for Ryan’s World, said the channel “cares deeply about the well-being of our viewers and their health and safety is a top priority for us. As such, we strictly follow all platforms terms of service, as well as any guidelines set forth by the FTC and laws and regulations at the federal, state, and local levels.”

The statement said that Ryan’s World welcomed the findings of the new study, adding: “As we continue to evolve our content we look forward to ways we might work together in the future to benefit the health and safety of our audience.”

Other popular children’s channels on YouTube show child influencers doing taste tests with Oreo cookies, Pop Tarts and Ben & Jerry’s ice cream or sitting in toy cars and ordering fast food at drive-throughs for Taco Bell, McDonald’s, Burger King, KFC and other chains. “This is basically a dream for advertisers,” said Dr. Bragg. “These kids are celebrities, and we know from other rigorous studies that younger kids prefer products that are endorsed by celebrities.”

To document the extent of the phenomenon, Dr. Bragg and her colleagues identified five of the top kid influencers on YouTube, including Ryan, and analyzed 418 of their most popular videos. They found that food or beverages were featured in those videos 271 times, and 90 percent of them were “unhealthy branded items.” Some of the brands featured most frequently were McDonald’s, Hershey’s, Skittles, Oreo, Coca-Cola, Kinder and Dairy Queen. The videos featuring junk food have collectively been viewed more than a billion times.

The researchers could not always tell which products the influencers were paid to promote, in part because sponsorships are not always clearly disclosed. The Federal Trade Commission has said that influencers should “clearly and conspicuously” disclose their financial relationships with brands whose products they endorse on social media. But critics say the policy is rarely enforced, and that influencers often ignore it.

McDonald’s USA said in a statement that it “does not partner with kid influencers under the age of 12 for paid content across any social media channels, including YouTube, and we did not pay or partner with any of the influencers identified in this study. We are committed to responsibly marketing to children.”

Last year, several senators called on the F.T.C. to investigate Ryan’s World and accused the channel of running commercials for Carl’s Jr. without disclosing that they were ads. The Council of Better Business Bureaus, an industry regulatory group, also found that Ryan’s World featured sponsored content from advertisers without proper disclosures. And a year ago the watchdog group Truth in Advertising filed a complaint with the F.T.C. accusing the channel of deceiving children through “sponsored videos that often have the look and feel of organic content.”

In March, Senators Edward J. Markey of Massachusetts and Richard Blumenthal of Connecticut introduced legislation to protect children from potentially harmful content online. Among other things, the bill would limit what they called “manipulative” advertising, such as influencer marketing aimed at children, and prohibit websites from recommending content that involves nicotine, tobacco or alcohol to children and teenagers.

The F.T.C. has long forbidden certain advertising tactics on children’s television, such as “host selling,” in which characters or hosts sell products in commercials that air during their programs. Critics say the agency could apply the same rules to children’s programs on the internet but so far has chosen not to.

“It’s beyond absurd that you couldn’t do this on Nickelodeon or ABC but you can do this on YouTube just because the laws were written before we had an internet,” said Josh Golin, the executive director of the Campaign for a Commercial-Free Childhood, an advocacy group.

“These videos are incredibly powerful,” he said. “Very busy parents may take a look at them and think that it’s just a cute kid talking enthusiastically about some product and not realize that it’s often part of a deliberate strategy to get their children excited about toys, or in the case of this study, unhealthy food.”

Anahad O’Connor is a staff reporter covering health, science, nutrition and other topics. He is also a bestselling author of consumer health books such as “Never Shower in a Thunderstorm” and “The 10 Things You Need to Eat.”

09/10/2020

COVID19 Second Wave is Happening in Europe 9/10/20

Europe is trying to get out of lockdown, but did not have the COVID19 epidemic under control, so the numbers are rising quite steeply, and look likely to be more than the first wave. I tried to put some graphs together, but it has proved beyond my computer management competence, so I can only refer readers to the Worldometers COVID home page and ask you to click on the individual countries and scroll down to the ‘New Infections’ graph if you want to check what I am saying.

The UK, Ireland, France, Belgium, the Netherlands, Portugal, Poland, Czechia, Austria, Denmark are all rising. Spain was following the same pattern, but has just started a new lockdown. Germany is ticking up, somewhat more modified, as is Norway. Sweden continues to have cases, but there is some doubt now about how they collect their figures.

The lesson for Australia is clear. We have to be conservative and go for elimination. Suppression will not work. There is danger that NSW has people no longer getting tested, presumably because admitting that an infection is possible means you have to self-quarantine for 2 weeks and have a nasty thing stuck up your nose, when you might just have a cold.

Daniel Andrews has taken the flak, but implemented a policy that has probably saved Australia. No thanks to Morrison, whose advice has been frankly mischievous.

Stephen Duckett, one of the architects of Medicare, tells it like it is.

www.smh.com.au/national/go-for-zero-what-victoria-can-teach-nsw-about-covid-19-20200908-p55tp2.html

06/09/2020

To Make google and Facebook pay, or not to make google and Facebook pay?

6 September 2020

Presumably the whole world is watching whether the Australian government can make google and Facebook pay to carry news items.

The reason is quite clear. They gain customers for being able to point them to the news sources, and then they get the advertising revenue from people on their platforms, while the people who collected the news make no money for having done so, and then lose the advertising that used to come to them when people bought their papers or watched their TV channels.

So initially I was quite in favour of the idea. Here were big foreign companies, structured to pay no tax, grabbing all the advertising and the media was dying because of the lack of advertising revenue. Strangely the ABC was not going to get any revenue- it was only going to the commercial media. I wondered if this was a good thing. Would google and Facebook favour the ABC as it was free, and direct people there rather than to commercial media. But if they did, would this produce a reaction from Murdoch, and would then the government do something more to favour Murdoch and disadvantage the ABC- hey, they are already cutting the ABC budget ?at Murdoch’s request.

But I was thinking that the rise of fake news and conspiracy theories, which threaten any rational voting or policy development is largely due to the social media behemoths. Everyone is equal in that they can post what they like, and things that are more interesting and clickable are more equal than facts. Added to this, in order to get people to stay there and click around, they are connected up with things and people that they like and who think like them. So we are all reinforced. We friend the people we like, and they friend us. And we get our facts from them, and they from us. So if we do not really chase facts in this candy store of pleasant experiences, we can soon have our own bubble, with no need for facts. Pontius Pilate has been much quoted for asking, ‘What is truth?’ He did not want to know what the truth was, and many who quote him are of the same mind. Exact truth may not always be clear, but you can get closer to it if you try, and hopefully that is what science and good journalism tries to achieve.

So when I saw the Australian government leading the world in trying to get revenue for the commercial media, when they had not even been able to get workable legislation to get them to pay some tax, I wondered who is driving this. The companies that have bought our privatised toll roads have the government collect their tolls, and fine people if they do not pay. So I wondered is this just Murdoch getting the government to collect revenue for him? Murdoch was very much in favour of the market as he gobbled up smaller media players. The Rudd and Gillard governments were ruthlessly attacked and ultimately destroyed by Murdoch, and it was always my opinion that this was because they would not change the media ownership laws to allow Murdoch to have nearly all of it- the need for balance and diversity being totally irrelevant and profits the only objective. As soon as Tony Abbott was Prime Minister this law was changed in Murdoch’s favour.

Now the market has changed. New technology has taken the money from newspapers and free to air TV, which were funded from their advertising. The model had worked reasonably well when I was young. The Fairfax family were rich from the advertising, and let the journalists write what they liked, or so we believed. With Packer, it was not quite so clear. The slogan was ‘Publish and be Damned’, but while that may have been true for more salacious material or less powerful targets, there was a suggestion that some areas were off limits, like tobacco when there was a lot of cigarette ads in the paper. Later, as Murdoch became more powerful, stories seemed to be changed a lot to suit his interest. When Indonesia had a very authoritarian government Murdoch’s coverage of it was very benign as he sought to get a satellite TV licence. This has advanced further so that now there is more advertorial content. Before local papers closed, people bought a quarter page ad and got to write the article on the rest of the page. Ideal for restaurants and clubs, but independent journalism? I think not, but it was/is the norm.

Once, stories were written first, then headline writers wrote the headlines for them. Now even senior writers are being asked to write a story to fit under a pre-written, catchy headline. Hey, we have to get a click to get the ad revenue. Senior writers have told me that the headline may be misleading and they have to slant their stories so it is not seen as absurd. What effect is this having? What about people who only read the headline? It no longer has substance- it was just put there so that they would notice it.

The ABC has been much criticised by the commercial media, and Murdoch in particular because it just gets money to provide a news and cultural service. It has a different funding model, and if the commercial media has no money, they want the ABC to have none either.

But it is time to look at the root cause. The model of funding media and journalism by advertising revenue is broken. It was fraying before google and Facebook etc came, and it is very broken now. Murdoch was quite happy to let the market sort it out, when he was winning and buying up his competition. Now he is getting the government to get him money from his technological competitors. And the Australian government, which seems more beholden to him than any other national governments is doing his bidding.

If google and Facebook decide to offer less news and change their algorithms to favour ‘free’ news sources, is this likely to affect the content of our searches? And will there be even more fake news and conspiracy theories than now? Quite possibly.

I have no particular brief to act for google and Facebook, and find their ads telling me that the end of the world is nigh almost laughable. I think that they must pay tax, and this must be based on their revenue, and not on the profits that can be so easily fiddled with foreign loans and transfer payments etc. But it seems that there are 3 related problems:

The government has a problem- how to get tax from these behemoths.
The public have a problem how to get unbiased honest news and science facts.
The commercial media have a problem how to pay their journalists when the revenue has gone to social media to whom trivia and produces just as much revenue as news.

We need to discuss this carefully, so that facts and public interest win.

www.reuters.com/article/us-australia-media-regulator/australia-to-force-google-facebook-to-pay-domestic-media-to-use-content-idUSKBN222066

28/07/2020

Workers Compensation in NSW and Victoria- ‘Immoral and Unethical’ – 4 Corners Exposes It. 28/7/20

This is what I have been saying for years. If you think the banks are bad, you have not dealt with insurers. They will do anything rather than pay people’s legitimate medical and living expenses.

My poor patients literally starve. They change their addresses each visit as they couch-surf their friends. The foreign patients with no Medicare cannot even get GP treatment, and because they are often paid sub-award wages in cash cannot even prove their incomes. Most specialists simply will not operate for the Medicare rebate, and even if they will the waiting time is a year. I tell the patients where the soup kitchens are. They are in huge pain and the most I hear from governments are warnings that they have been on narcotics too long, as they wait for the surgery that the insurers have refused to pay for.

The patient Scott with his supportive wife, at the beginning of the 27/7/20 4 Corners tells the story of his shattered life, which is just like what my patients tell me.

The Victorian the Ombudsman, Deborah Glass did an investigation into WorkSafe Victoria, the callous government insurer there. She found appalling behaviour and says so very clearly.

In NSW it is the same- the appalling, hopeless iCare, who should be called ‘I Don ‘t Care’ put together a bunch of insurance executives who had no experience in working with people. They all got awarded huge salaries and set about having computer algorithms to replace claims clerks. So when a claim goes wrong (which takes a while to figure out as 3 week delays are pretty much the norm), you call and ask to speak to the case manager. You can’t. But if you persist eventually you find one, but he or she only got the claim yesterday. i.e. There had been no person managing it until you hassled like hell, and it is often refused anyway.

Meanwhile the patient had no treatment and the fat cats at the top had not noticed that their system had a few glitches. And most of the concern in both the management echelons and the media is about some financial deficit which, if we are to believe the totally out-of- touch iCare CEO, Ken Nagle, depends how you do the accounting.

No one seems to remember that this is just a health insurance scheme to help Workers’ Compensation and Motor Vehicle accident Victims. If Medicare worked it would be completely unnecessary, and it cannot even manage to function like a private health insurer. It assumes that all doctors are crooks who cannot be trusted to order just the tests and operations necessary- they all have to be evaluated and denied by insurers who get every dollar that they refuse to pay, and who seek out dodgy doctors to carry out ‘Independent Medical Examinations’ (IMEs) to deny normal treatments. If the IME doctors do not do what the insurers want they get no more work from them.

The directors and top executives of iCare should be sacked and the whole thing given to ICAC to examine. ICAC needs more resources also.

SIRA (State Insurance Regulatory Authority) has been more hopeless than ASIC and APRA were with the banks, and should be abolished also. This story came from a whistle-blower, not from SIRA, the responsible agency, though some of us have been trying to get SIRA to act for years.

SIRA became a bit more interested after the Hayne Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry reported in February 2019, presumably as they realised that if the Commission has been given enough time to look at insurance, they would have had their own hopeless regulatory efforts scrutinised. They had an internal investigation, the Dore Inquiry (no, you almost certainly have not heard of it), but it did actually find that iCare was behaving appallingly. The report release was delayed 5 months (July-December 2019) and released just before Christmas with iCare’s reaction, which was to admit that they had made ‘mistakes’ and that they accepted all the recommendations. Great PR! Released on a busy day to avoid scrutiny and if you as a journo were a tiny bit interested, there was no story because iCare accepted the changes suggested. The SIRA strategy worked- no scrutiny of either iCare or SIRA.

At last there is a 4 Corners on this! Watch it if you missed it!

Let us hope that when it goes to ICAC some major changes are achieved. It seems that 4 Corners is the only regulatory force in the country. I guess that is why the government wants to de-fund the ABC.

https://youtu.be/fxIvKogrE2Q

11/07/2020

Happenings in Turkey, no sillier than NSW mining policy 11/7/20

A friend has sent me this to illustrate how life is in Turkey these days under President Erdogan, who fancies himself the new Kemal Attaturk. Ataturk however was the victorious general at Gallipoli and the founder of the modern Turkish state on the ruins of the Ottoman Empire after WW1. He wanted a modern, democratic, secular state an instituted a new western-style alphabet.

Erdogan has undermined democracy and concentrated power in his own hands. He claims to be Muslim and been a very divisive figure, playing to the less educated eastern side of the country against the more educated secular western side. He had fantasies of leading the Muslim world while building the country with borrowed money, principally in real estate investment. The quality of these high-rise buildings in earthquake -prone Istanbul will no doubt be tested in time. The economy is not doing well, particularly in the COVID19 crisis. This little story about digging up a glacial lake is a micro illustration of his capricious rule, which has involved things like emptying the prisons and locking up journalists and academics who oppose him.

Such stupidity does not only occur in Turkey. If it is foolish to undermine a little lake and dig a hole that cannot be filled underneath it, how much sillier is it to allow long wall mining under the catchment of a large, growing capital city that is prone to drought. Cracks will go from the surface to the mine depth and then the water will run out to sea. We should ask ourselves why we tolerate the NSW government, and Peabody, a US owned mine.

www.quora.com/What-happens-only-in-Turkey/answer/Simge-Topaloğlu?ch=1&share=02eab1a8&srid=zByA