Doctor and activist


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Category: Health

29/03/2025

2025 March Budget Response

27 March 2025

Warning. This is a long post, with my opinion followed by a more detailed analysis from Zali Steggall.

Treasurer Jim Chalmers has now brought down his March pre-election budget.

All the noise is about the few sweeteners, the $150 electricity rebate (paid to the companies that are maintaining the prices), and a very modest tax cut, coming in the future, and perhaps not even enough to overcome bracket creep.

In the nine and half page analyses in the SM Herald the next day, not one got down to any sort of real discussion of the details. Ross Gittins summed up the situation best with his closing comment, ‘This government is timid, uninspired and uninspiring. This budget fits it perfectly’.

To look in more detail, I got an email from Zali Seggall, the Teal from Warringah, a barrister and ex-Olympic skiing medallist who defeated Tony Abbott, the then Prime Minister to win the seat. She at least had done her homework, though she skirts some of the bigger issues that might be politically sensitive for her, as she also faces her conservative electorate in a few weeks.

If the standard to measure budget is what needs to be done, it is quite a poor budget, mostly just business as usual with only little tinkering, but that has been the whole approach of the Albanese government, and why the Greens are rising on the Left of the Labor Party, and the Teals are rising on the left of the Liberal Party.

There is minimal for Climate Change, dwarfed by the subsidies for diesel fuel and the fossil fuel lobby.

There is no discussion of tax reform, though negative gearing and the capital gains tax concession is responsible for the huge amount of ‘investment’ in property speculation, which also raises rents and means that poorer people cannot get Housing. This also affects domestic violence as women have nowhere to go, crime and kids unable to start a family. Research gets little, and the National Anti-Corruption Commission and Australian Electoral Reform Commission to stop electoral disinformation is similarly neglected. Defence has a tiny increase presumably to please Trump, or try to remedy the fact that the US cannot be relied upon, but the huge issue of the AUKUS submarines is not addressed in the Budget, nor by Zali. Aged Care needs a lot of policing as do many privatised industries. Medicare will supposedly be revived, but they are still having trouble recruiting GPs and nurses. No prizes for guessing why. The government has had control of the wages and rebates and has simply let them fall against inflation. There has been some tinkering with Medicare, but the GPs and nurses remain unconvinced.

But if you think that Labor was poor on policy, you need to think about the Liberal’s effort in reply on 27th. Dutton wants to lower the petrol temporarily. This will naturally favour commuters with big cars in outer suburban marginal electorates. It will also be bad for Climate Change and delay electrification of the car fleet. He wants to solve the energy crisis by producing more gas by fracking NSW (sorry environment again), sack 40,000 public servants (about half of Canberra’s public servants, who will presumably be replaced by private consultants at twice the price), and of course his nuclear policy for expensive electricity in never-never time. (We need not mention that the coming large-scale renewables need supplementation that can be turned on and off, and nuclear does better at producing a constant flow).

But since the new politics seems to be that you criticise your way into power, perhaps he has a chance. One observer looking out for Liberal policy says the best guide is Gina Reinhardt’s Twitter (X) feed, but I have not researched the veracity of this.

Here is the article from Zali Steggall:

Budget
With $17 billion in tax cuts, this budget will benefit working Australians, but the government has again avoided meaningful tax reform. Of note, there is a downgrade to revenue from weak Petroleum Resource Rent Tax (PRRT) with forecast revenue slashed from $10 billion to $6.3 billion by 2026-27. Australia is collecting more tax from beer drinkers than fossil fuel companies. The government has again failed to scale back support through the diesel fuel tax credits for mining companies, now predicted to increase to $46 billion.

The extension of the energy bill relief ($150) is welcome but not means tested so includes an element of spending waste. Continued investment in community batteries and social housing electrification are steps in the right direction. However, there remains an urgent need for the government to prioritise renewable household energy through rooftop solar and battery programs which offer lasting cost-of-living reductions and emissions cuts.

The budget includes a number of positive measures in health and education, particularly for women’s health and affordable childcare, and continues some investment in future-facing industries like green metals.

One of the most promising developments in the budget is the government’s adoption of the Productivity Commission’s recommendation to eliminate non-compete clauses for low and mid-income workers—a measure that while not a headline grabber, will provide a much need boost to productivity and labour mobility.

It was also good to see a modest increase in foreign aid, in line with calls for Australia to strengthen its leadership in the region.

However, this budget fails to respond adequately to the climate and nature crises. Alarmingly, fossil fuels continue to receive six times the funding allocated to nature. There is no meaningful investment in environmental protection, or additional funding for an EPA despite the enormous and growing fiscal impact of natural disasters.

It’s a false premise to think we can prioritise a cost-of-living budget over climate measures as climate change is already costing us, and the longer we wait to mitigate and adapt, the more expensive it will be.

It is disappointing that the government announced a mere $28.8m over two years to ‘improve Australians resilience to natural hazards and preparedness to response to disasters’ in the same section it notes that Cyclone Alfred is estimated to cost $13.5b in disaster support and recovery. Piecemeal upgrades to roads in marginal electorates do not constitute a genuine resilience strategy.

Defence spending is accelerating, but national security isn’t just about weapons and wars – it’s about regional stability. Defence spending alone isn’t enough. When disasters strike, fragile infrastructure turns climate shocks into prolonged crises, fuelling unrest and displacement. True security means helping our neighbours build resilience before disaster strikes.

JobSeeker and Youth Allowance remain unchanged, so our most vulnerable are falling further below the poverty line. There is also a glaring gap in support for women and children escaping domestic violence, with only a $2.5 million increase for crisis accommodation—far below what is needed to address the scale of the crisis.

Climate and Environment
• No significant funding uplift for climate resilience and adaptation.
• Over $46 billion on fuel tax credits. This is six times more than funding for environmental protection.
• Downgrade in revenue forecast of the government’s weak petroleum resource rent tax.
Commentary:
• The government has acknowledged that climate change is expected to have a significant impact on the Budget, both in terms of risks and opportunities. However, there has been no new funding for climate adaptation and resilience, simply $28 million of targeted funding, including $17.7 million for the Bushfire Community Recovery and Resilience Program.
• The aftermath of ex-Tropical Cyclone Alfred has been felt throughout this Budget. With $1.2 billion allocated for disaster relief, the full cost is anticipated to rise to $13.5 billion.
• In terms of funding for disaster resilience, there has been little foresight to keep our communities safe with only $200 million expected to be provided over the forward estimates from the Disaster Ready Fund. Disappointingly, we also see a decrease of funding to the National Emergency Management Agency to assist with planning and preparing of future disasters from $27 million in 2025-26 to $12 million in 2028-29.
• We are still waiting for the government’s National Climate Risk Assessment and National Adaptation Plan to understand the full extent of climate risk for our communities. Unfortunately, the extent of new climate resilience investment is limited to flood proofing three roads with $354 million over the forward estimates.
• Despite the Government committing to better monitoring and reporting of methane emissions, there was nothing in the budget. It is disappointing that this funding was not prioritised given how critical it is that our emissions inventory has integrity to achieve the government’s 43% emissions reduction target and commitments under the Paris Agreement.
• In terms of nature, I welcome the government’s announcement of $250 million to fund Australia’s obligation to protect 30% of Australia’s bushland by 2030, but this is a far cry from the $5 billion estimated by the conservation sector. In addition to this, there is great hypocrisy in the $2 million in additional funding for protection of the Maugean Skate captive breeding program, when the government today rammed through legislation that puts the endangered species at risk.
Financial Relief for Individuals and Small Business
Progress
• Reforming Help to Buy Program to increase income threshold and house price limit
• Tax cuts for all Australians.
• $150 energy bill relief for every household and some small businesses.
• HELP changes come into effect – a 20% debt reduction, fairer indexation, and raising the minimum repayment threshold to an annual income of $67,000.
Falls Short
• Commonwealth Rent Assistance indexed but not increased.
• No ongoing funding for instant asset write-off, and no meaningful support for small businesses.
Commentary:
• It’s great to finally see the reforming of the Help to Buy scheme to start to match house prices in Warringah. Warringah has around 1% vacancy rate for rental properties and the average dwelling is more than $1 million. First home buyers are struggling to get their foot in the housing market, and this will help – but more needs to be done to reduce the cost of buying a home. However, there is still nothing to assist or support renters.
• I welcome the government’s investment into household electrification, including the continued funding of the Community Solar Banks Program and the Household Energy Upgrades Fund for supporting public and community social housing with electrification. This not only drives down emissions but also helps to bring energy bills down.
• For small business, there is limited financial relief in this Budget. The end of 2024 saw the highest number of insolvencies for small business over the past four years – our small businesses are struggling. We need to legislate a permanent instant asset write off for at least $50,000. It is vital that the Government legislates and makes this available to small businesses without delay.
• With cost-of-living pressures, it is concerning that there is no substantive uplift in Jobseeker, Youth Allowance, Austudy and Commonwealth Rent Assistance. I continue to advocate for the government to increase income support payments, such as JobSeeker, Youth Allowance and Parenting Payment, to at least $82 a day.
Economy and Industry
Progress
• $1 billion over 7 years for the Green Iron Investment Fund.
• $750 million for green metals.
• $2 billion for the Clean Energy Finance Corporation.
• $20 million to support trade diversification with India.
• $54 million to increase supply and adoption of pre-fabrication and modular homes to help increase Australia’s housing supply.
Falls Short
• Budget deficit.
• No new funding for circular economy initiatives.
Commentary:
• There’s been talk on both sides of the growing deficit however, there is limited announcements on how we are going to grow the economy through increased productivity. The Government’s already announced $900 million National Productivity Fund provides an avenue to grow a skilled workforce and push out productivity measures, including the $54 million for prefabricated and modular homes and to prohibit non-compete clauses for low- and mid- income earners. However, meaningful, long-term policies and spending are still needed to continue to grow our productivity.
• There is some movement by the Government to decarbonise key industries, with $250 million for manufacturing low carbon fuels for sustainable aviation and diesel-reliant sectors, including transport, agriculture and construction. I also welcome the New Energy Apprenticeships Program and national electrician licensing program to support Australia’s energy transition.
• The $20 million for a Buy Australian campaign, which appears to be the only measure the Government has included to address growing tariff and trade war tensions, feels a bit misplaced. In the face of increased uncertainty, the government has foregone any new funding to push for greater research and innovation programs.
Defence and National Security
Progress
• Funding for building Australia’s domestic defence industry and capabilities.
• Additional $135 million in funding for foreign aid.
Falls Short
• No new funding for the Defence Net Zero and Defence Future Energy Strategies.
Commentary:
• Increased global tensions has meant that Australia’s previous heavy reliance on the US as our security backstop can’t be relied on anymore. As a result, there has been additional $1 billion dollars provided to defence in the Budget. This has been bundled with the $9.6 billion in defence funding that was already planned to be spent over the next four years.
• It’s going to be vital to have clear KPIs and deliverables from such an increase in defence spending to ensure that Australia gets value for money and necessary capabilities.
• I welcome the $5.1 billion allocated in Australia’s aid program. This announcement is a timely and much needed signal of our regional commitment and reversing the long-term decline in funding.

Safety at Home, Work and Online
Progress
• $6 million for ACCC’s National Anti-Scam Centre.
• $21.4 million for the implementation of the Australian Law Reform Commission inquiry into the justice responses to sexual violence in Australia.
• $175 million for NDIS integrity and cracking down on fraud.

Falls Short
• No funding for gambling advertising reform.
• No commitment to implementing an online duty of care or holding big tech to account.
• No new funding for Indigenous legal services, despite calls from the National Aboriginal and Torres Strait Islander Legal Services for $1.15 billion.

Commentary:
• Aside from the funding to the ACCC’s National Anti-Scam Centre, there has been limited funding to online safety with no new funding for the e-Safety Commissioner’s work on keep young people safe online.
• Australia continues to face a crisis of women’s safety, yet while the investment of $21.8 million over 2 years for First Nations early intervention and prevention, only a mere $2.5 million has been allocated to crisis accommodation for women and children, which will make little to no difference at a national scale.
• It’s a strong start to see the allocation of $21.4 million in funding to over 3 years to implement the recommendations of the Australian Law Reform Commission’s Inquiry into the Justice System’s Response to sexual violence.

Education
Progress
• Full funding to government schools.
• $1 billion to establish the Building Early Education Fund to increase the supply of high-quality early childhood education.
• Three Day childcare Guarantee funded with $426.6 million.

Falls Short
• No measures to implement real time processing of HECS debt repayment to address indexation timing inequity of HECS.

Commentary:
• An additional $407.5 million will see that government schools receive full funding under the School Resource Standard.
• Investment into the early childhood education fund, paired with the 3-day childcare guarantee, is an important and necessary measure to support young families and assist young parents in returning to the workforce.
• A modest investment of $4.8 million is welcome to ensure the continuation of education programs to encourage update of STEM.
• The current Fee-Free TAFE agreement between the Commonwealth and state governments expires in 2027. I welcome the commitment to continue funding the Fee-Free TAFE program, as VAT.

Health and Wellbeing
Progress
• $7.9 billion for Medicare to increase bulk billing services and incentivise GPs to bulk bill patients.
• $793 million funding for women’s health initiatives, such as additional contraceptive pills on the PBS, menopausal hormone therapies added to PBS and 11 more endometriosis and pelvic pain clinics.
• $43.6 million over 4 years for treatment of neuroendocrine tumours.

Commentary:
• A number of promises have been made during the course of the election campaign that are now reflected in the budget but there are no significant new measures.
• I welcome the focus on women’s health with $793 million funding for initiatives, such as oral contraceptive pills on the PBS, and efforts to lift support and care provided by GP’s for women experiencing menopause.
• With just over 50% of all medical appointments bulk billed in Warringah, the cost of healthcare is a concern within our electorate. The government announced a lofty goal of 9 out of 10 doctor visits, however, I question whether this is realistic.
• Further, the capping of PBS prescription medication at $25 dollars is welcome, but more needs to be done to ensure that the cost of the PBS medicines doesn’t blow out the budget.
• An announcement of $291.6 million over 5 years to implement aged care reforms is welcome although will do little to address the significantly long wait times to access aged care services in the short term.
• Funding of $1.8 billion for public hospitals is welcome to assist state governments deal with strained emergency services in public hospitals.
• Efforts to address GP shortage with $663 million in funding to create more pathways for GPs and nurses. This is necessary measure in making healthcare more accessible.
• The investment into medical research and particularly rare cancers is important in promoting the health of everyone in our community. This includes $158.6 million over 5 years for the Zero Childhood Cancer Precision Oncology Medicine Program and the Australian Rare Cancers Portal.
• There are also some minor investments in sport that promote inclusion. I welcome the $3.2 million for the Australian Sports Commission to support women’s participation in sport.

Conclusion
On balance, I give this budget a C+ as it represent cautious fiscal management in challenging geopolitical and economic circumstances but it lacks the ambition and reform required to address climate risks, close equity gaps and secure a strong, fir economy for future generations.
Disappointingly, we see noi new funding for the Australian Electoral Reform to assist with tackling disinformation during the election campaign.
There are no new measures positioned to strengthen the existing National Anti-Corruption Commission.

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26/02/2025

Vale Marg White

26 February 2025

Marjorie Irene White (just call me Marg) died on 18 December 2024. She was the doyen and major organiser of the Melbourne activists of MOP UP (Movement Opposed to the Promotion of Unhealthy Products) and later BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions). The difference between the two groups was that MOP UP confined itself to legal activities, and BUGA UP did not.

Marg was born in 1930 in Macksville, the only child of Frank and Irene Macrae. Frank was a farmer, who took Marg everywhere he went, so she developed a handy range of practical skills and good self confidence Her mother was a schoolteacher and she helped her mother and acquired a love of teaching.

They moved to Kendal in 1937 and she was somewhat protected from the Depression as her father could grow food and her mother’s teaching job remained. Later Kendal, a town of only 600 people, was where the troop trains stopped on their way to northern Australia and Papua New Guinea. She was a popular youngster as she took treats to the troops. Frank bought a small weekender at Bonny Hills where the family spent holidays. He later retired there.

She was very musical and a good student, topping NSW in geography and going on to Uni in Armidale and then Sydney Uni where she did a BA and Dip Ed and specialised in early childhood education, believing that lessons learned early were the most important. She met her future husband, David Ogilvie White, who had got into medical school at 16, but was more interested in playing chess. She pushed him to do more work and actually pass. They married in 1954 and went to ANU in Canberra where she met Bob Hawke and Hazel, resulting in a lifelong friendship. Consistent with her idea that everyone should reach their full potential she encouraged Hazel to get a degree when Bob was not keen on this. They remained great friends, with Bob and Hazel staying with them in Melbourne. David’s career blossomed and he rose in the academic ranks becoming Professor of Virology and head of Infectious Diseases at Melbourne University.

She became involved with MOP UP (Movement Opposed to the Promotion of Unhealthy Products) and had quite a large corps of medical students who were keen to help. Some of their stunts were very effective. MOP UP made a graveyard with satiric names based on tobacco brands and handed out leaflets outside the Marlboro Australian Tennis. The sponsorship was dropped in 1985. The Royal Philharmonic Orchestra was met with a group of protesters in black tie outfits playing mock instruments as ‘The Royal Carcinogenic Orchestra.’ They also dropped their Benson and Hedges sponsorship. MOP UP continued street theatre and leafleting while BUGA UP refaced cigarette billboards, and occasionally alcohol or offensively sexist ones. Marg quietly worked as an organiser, but not merely of the activists, keeping in contact with the political and medical establishments, writing letters and encouraging progressive initiatives.

She was happy to contribute directly to the BUGA UP campaign; standing at a tram stop in a houndstooth tweed suit, complete with cape, she would reface the cigarette ad on an arriving tram, then stand back, spray can under her cape looking like the super-respectable middle aged schoolteacher that she was. If you were getting on or off the tram or blinked you would have missed it.

At that time the tobacco industry used ‘shop panels’, cigarette ads about 50x90cm stuck on each side of the doors of convenience stores with two-sided tape. They stuck well enough, but could be prised off easily with either a claw hammer or small jemmy. Marg went out with an activist one night to clean up the shop panels which her companion removed and stacked in the backseat of her car. There were few security guards and no CCTV cameras in the mid 1980s, but they were spotted and hailed. Her companion ran off and she drove away, but the Police had been alerted, so she was chased with Police lights flashing and sirens blaring. She pulled over and the officer who came to car window was flabbergasted to see a respectable grey-haired woman. ‘What are you doing?’ he asked. ‘I am just on my way to pick up my daughter from the ballet’ answered Marg calmly. ‘Oh, sorry lady’, said the Policeman. The story goes that he got a hard time back at the station and was told, ‘Yes, that was her; that is the exact description’. Meanwhile Marg hurried home and put the shop panels under the house in case the police returned. They never did.

Marg was a philanthropist and gave money to the Melbourne Symphony Orchestra and the Australian Ballet, as well as the Australian Conservation Foundation. She was an environmentalist and fought for causes she believed in, successfully funding an expensive QC to stop a canal development at Laurieton in NSW near the family weekender at Bonny Hills. The success of that case became a template for similar residents’ actions.

She was active in many roles in the Australian Democrats and became President of the Victorian division when they were a significant force in Australian politics. At home, she nursed her husband who had liver failure, probably occupationally acquired.

Her greatest achievement is probably the Victorian Tobacco Act of 1987. The Western Australian government had tried to ban tobacco advertising in 1983, but were beaten by sports associations that complained that they would founder without tobacco money. So the Victorian Tobacco Act sought to increase tobacco tax and use the money to buy out the sponsorships of sports, cultural events and all the other entities that had been bought by tobacco, as well as funding medical research and doing health promotion to take up the empty billboards among other initiatives. It was the first Health Promotion Foundation in the world, and the legislation passed by one vote. Nigel Gray, doyen of the Establishment and head of the Anti-Cancer Council of Victoria said that the legislation would never have passed without the public support generated by the activist groups, of which Marg was a critically important member.

She is survived by three daughters and two grandchildren.
Marjorie Irene White (just call me Marg) died on 18 December 2024. She was the doyen and major organiser of the Melbourne activists of MOP UP (Movement Opposed to the Promotion of Unhealthy Products) and later BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions). The difference between the two groups was that MOP UP confined itself to legal activities, and BUGA UP did not.

Marg was born in 1930 in Macksville, the only child of Frank and Irene Macrae. Frank was a farmer, who took Marg everywhere he went, so she developed a handy range of practical skills and good self confidence Her mother was a schoolteacher and she helped her mother and acquired a love of teaching.

They moved to Kendal in 1937 and she was somewhat protected from the Depression as her father could grow food and her mother’s teaching job remained. Later Kendal, a town of only 600 people, was where the troop trains stopped on their way to northern Australia and Papua New Guinea. She was a popular youngster as she took treats to the troops. Frank bought a small weekender at Bonny Hills where the family spent holidays. He later retired there.

She was very musical and a good student, topping NSW in geography and going on to Uni in Armidale and then Sydney Uni where she did a BA and Dip Ed and specialised in early childhood education, believing that lessons learned early were the most important. She met her future husband, David Ogilvie White, who had got into medical school at 16, but was more interested in playing chess. She pushed him to do more work and actually pass. They married in 1954 and went to ANU in Canberra where she met Bob Hawke and Hazel, resulting in a lifelong friendship. Consistent with her idea that everyone should reach their full potential she encouraged Hazel to get a degree when Bob was not keen on this. They remained great friends, with Bob and Hazel staying with them in Melbourne. David’s career blossomed and he rose in the academic ranks becoming Professor of Virology and head of Infectious Diseases at Melbourne University.

She became involved with MOP UP (Movement Opposed to the Promotion of Unhealthy Products) and had quite a large corps of medical students who were keen to help. Some of their stunts were very effective. MOP UP made a graveyard with satiric names based on tobacco brands and handed out leaflets outside the Marlboro Australian Tennis. The sponsorship was dropped in 1985. The Royal Philharmonic Orchestra was met with a group of protesters in black tie outfits playing mock instruments as ‘The Royal Carcinogenic Orchestra.’ They also dropped their Benson and Hedges sponsorship. MOP UP continued street theatre and leafleting while BUGA UP refaced cigarette billboards, and occasionally alcohol or offensively sexist ones. Marg quietly worked as an organiser, but not merely of the activists, keeping in contact with the political and medical establishments, writing letters and encouraging progressive initiatives.

She was happy to contribute directly to the BUGA UP campaign; standing at a tram stop in a houndstooth tweed suit, complete with cape, she would reface the cigarette ad on an arriving tram, then stand back, spray can under her cape looking like the super-respectable middle aged schoolteacher that she was. If you were getting on or off the tram or blinked you would have missed it.

At that time the tobacco industry used ‘shop panels’, cigarette ads about 50x90cm stuck on each side of the doors of convenience stores with two-sided tape. They stuck well enough, but could be prised off easily with either a claw hammer or small jemmy. Marg went out with an activist one night to clean up the shop panels which her companion removed and stacked in the backseat of her car. There were few security guards and no CCTV cameras in the mid 1980s, but they were spotted and hailed. Her companion ran off and she drove away, but the Police had been alerted, so she was chased with Police lights flashing and sirens blaring. She pulled over and the officer who came to car window was flabbergasted to see a respectable grey-haired woman. ‘What are you doing?’ he asked. ‘I am just on my way to pick up my daughter from the ballet’ answered Marg calmly. ‘Oh, sorry lady’, said the Policeman. The story goes that he got a hard time back at the station and was told, ‘Yes, that was her; that is the exact description’. Meanwhile Marg hurried home and put the shop panels under the house in case the police returned. They never did.

Marg was a philanthropist and gave money to the Melbourne Symphony Orchestra and the Australian Ballet, as well as the Australian Conservation Foundation. She was an environmentalist and fought for causes she believed in, successfully funding an expensive QC to stop a canal development at Laurieton in NSW near the family weekender at Bonny Hills. The success of that case became a template for similar residents’ actions.

She was active in many roles in the Australian Democrats and became President of the Victorian division when they were a significant force in Australian politics. At home, she nursed her husband who had liver failure, probably occupationally acquired.

Her greatest achievement is probably the Victorian Tobacco Act of 1987. The Western Australian government had tried to ban tobacco advertising in 1983, but were beaten by sports associations that complained that they would founder without tobacco money. So the Victorian Tobacco Act sought to increase tobacco tax and use the money to buy out the sponsorships of sports, cultural events and all the other entities that had been bought by tobacco, as well as funding medical research and doing health promotion to take up the empty billboards among other initiatives. It was the first Health Promotion Foundation in the world, and the legislation passed by one vote. Nigel Gray, doyen of the Establishment and head of the Anti-Cancer Council of Victoria said that the legislation would never have passed without the public support generated by the activist groups, of which Marg was a critically important member.

She is survived by three daughters and two grandchildren.

Continue Reading

27/01/2025

NDIS and Health System in Crisis- what is the answer?

27 January 2025

The health system has been in crisis for years and now NDIS is the same.
State and Federal governments are locked in crisis talks, and now the NDIS is over budget and looking to ‘transfer services’ to other parts of the health system.
Why does all this go on, and what is the solution?
The short answer is that there are many sources of health funding and the main policy objective of all of them is to transfer the cost to someone else, and if they are a private source, to maximise the profit.
This ‘transfer costs’ imperative means that no one is concerned about the overall cost, merely their bit of it.
The major players are still the State and Federal government. In simple terms the States look after the hospitals and the Federal government looks after non-hospital services.
Medicare is being starved and pays less and less to doctors relative to inflation. The private health funds pay what they have to, the CTP (Motor Accidents) and Workers comp systems are either private or use a private model and pay as little as they can get away with and the patient pays the gap, unless they decide that private health insurance is not worth the money, which in most cases is true, and get a bit of Medicare and pay the rest.

Examples of cost shifting are easy to find. The Federal government has let Medicare rebates to GP fall to 46% of the AMA fee. It was 85% when Medicare started, so many doctors simply don’t bulk bill and charge a fee. So people go to the Emergency Departments that are free, but funded by the States. A visit to the ED is 6x more expensive than a GP visit, but the Federal government has shifted the cost to the States, so they don’t care. When you go to the ED and get a script, the hospital used to give you all the drug course. Now they give you a few tablets and a script for a pharmacy outside. The script was needless, and generates the costs of the trip to the pharmacy, the pharmacists fee, the PBS Federal government contribution and the patients script fee. A lot of wasted time and money, but the State saved a bit. When you went to the ED, you used to be followed up in a hospital outpatient clinic where the consultant was paid a sessional fee and oversaw registrars checking the cases and learning. You could also just book and go to a specialist clinic. These have largely been stopped to save the State money. Now you go to the specialists’ rooms and the State saves money, but the total cost per visit is much more.

If you look at the overall efficiency of health systems, Medicare as a universal system has overheads of about 5% counting the cost of collecting tax generally. Private health insurance overheads in Australia are about 12%, Workers comp 30% and CTP over 40%. These figures are approximate and very hard to get, because the dogma is that competition drives down prices, when clearly the system is more efficient if there is a single paying entity. Interestingly, the Productivity Commission made no attempt to quantify these overheads when it looked at the cost of the health system- you may ask why. The point is if you take out profits, which are the same as overheads from the patients’ point of view, and make everyone eligible, you do not have to have armies of insurance doctors, investigators, lawyers and tribunals to see if the insurer has to pay or if it can be dumped on Medicare and the patient.
As far as foreign people using the system are concerned, universal Medicare for people living in Australia is administratively simple, and the cost of treating tourists who have accidents is cheaper than policing the whole system. Enforcement has quite high costs.

In terms of the cost of insurance, US schemes vary from 12-35%R, with the high costs ones being most profitable as they police payouts more thoroughly and naturally refuse more treatments. Note that the CEO of Unitedhealthcare in the US was recently shot, with the words ‘deny’ and ‘delay’ on the cartridges used. Surveys have shown that 36% of people in the US have had a claim denied. Claims are accepted here, but in a survey of my patients 60% of my scans and referrals of CTP patients were denied by NRMA. i.e, We accept the claim, but deny the treatment.

What Is needed is a universal system, free at the point of delivery.
What about over-servicing? The current system makes trivial problems of people with money more important than major problems of people without money. Underservicing is the major problem with ambulance ramping at EDs and long waiting lists.
In a universal system, which doctor is doing what is immediately accessible, with comparisons to every other doctor doing similar work. It is just a matter of checking up on the statistical outliers.

The problem is simple. The major political parties are given donations by private health interests to let Medicare die. Combine this with the Federal/State rivalry that makes cooperation very difficult and a reluctance to collect tax and you have the recipe for an ongoing mess.

The NDIS is an even bigger mess. It is a privatised unsupervised welfare system that arbitrarily gives out money and is subject to massive rorting.

The welfare system that looked after people with disabilities, both congenital and acquired by age or circumstance had grown up historically in institutions that were fossilised in their activities and underfunded to prevent expansion or innovation. People with disabled children looked after them with whatever support they could find. As these disabled cohorts reached middle age, their parents, who were old, were worried about what would happen when they died and wanted to lock in funding for their adult children before they died. They were an articulate lobby group with real problems and were quick to point out the flaws in the existing systems. They visited institutions that had no vacancies and thought that they had put their names on waiting lists. But no central list existed, and the institutions tended to give their beds to whoever came first when a death created a vacancy. ‘Just give us a package, and we will decide how to spend it’ was the parents’ cry. But then NDIS experts came in and interviewed people and gave away ‘packages’ based on an interview. A new layer of experts was created. District nurses or others who might have been able to think of more innovative or flexible options, or who could judge who in their area needed more than someone else had no input. People with real disabilities were given money, but did not know how to assess providers, so dodgy operators snapped up the packages, delivering dubious benefits. The government had no serious regulation or control system. Now the cost of NDIS has blown out, so the solution is to narrow eligibility and force people off the NDIS and onto other parts of the health system. Sound familiar? People with disabilities and their relatives are naturally worried; and rightly so. The lack of these services was why the NDIS was created. The answer is to have universal services. Set a standard, make it available and police quality in the system. Private interests may have a place, but there is no need for profits, non-profit organisations have been the mainstay of providers for years. For profit providers tend to cut costs, which in practical terms means either services or wages or both to concentrate on shareholder returns. The best way to allocate resources optimally is to empower the people actually doing the job, who also have the advantage of being able to see relative needs as they go about their routine work.

An interesting tome on the subject is ‘The Political Economy of Health Care’ by Julian Tudor-Hart, which looked at the changes in the British National Health System from when it started as an idealist post-war initiative run by those working in it with management overheads of about 0.5%, to when it was fully bureaucratised with overheads of about 36%. He was also responsible for the ‘’Inverse care law’ which is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.

The key point of that people have been taught that governments are hopeless and that you should pay as little tax as possible, so instead of good universal services being developed, a market has developed which is on its way to an American system.. People all agree that the US has the worst system in the developed world at delivering health care. But they overlook the fact that the US health system is the world’s best at turning sickness into money. That is what it was designed to do and that is why it is sustained and maintained. The same drivers are all here.

Note the Federal/State bickering in the article below (and weep).

My recipe for change is to have a Swiss style of government where the people can initiate binding referenda on governments and could simply answer a question like ‘Do you want to pay 5% more tax to have a universal health and welfare system?’ If a question like this got up against the doomsayers, we might have a chance. But of course the change to the constitution to get the referenda in the Swiss model is almost impossible to achieve, the Swiss having been discarded when the Australian Constitution was written in about 1900.

www.thesaturdaypaper.com.au/news/politics/2025/01/25/exclusive-albanese-shut-down-hospital-talks-pressure-states?utm_campaign=SharedArticle&utm_source=share&utm_medium=link&utm_term=VT5jI6Zo&token=Z3cA3Py

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15/12/2024

Banks Charging $3 a withdrawal- the logical end of capitalist thinking?

11 December 2024
Once upon a time banks functioned to store your money safely giving you some interest for the use of it or lending it to you for a bit more interest.
Then the government made a quick buck by selling the bank to people who had the money to buy shares.
Then the concentration of wealth changed so that most of the money was held by fewer people. And technology changed and the people with the most money used the new higher tech ways of banking.
And then there was less profit in the little people.
And the accounting changed, the CEO salaries went from several tens of multiples of the normal people’s salaries to hundreds of times. But they had to show results to the shareholders to justify this.
So they closed most of the branches and replaced them by Automatic Teller Machines to save all those rents and staff salaries.
And they decided that even to stock the ATMs was too expensive so they put fees on them to use them, but they got criticised for that, so they lessened the number of ATMs, which saved even more.
A few people actually still wanted to go to the few branches left and wait until they could get to the reduced service, but the accountants said that the return on capital to the shareholders from this aspect of operations was not as much as the returns on internet transactions. Clearly the shareholders wanted ‘user pays’ in every aspect of the business so the banks decided to make these little folk pay a fee to get their own money, as had been so successful with the ATMs.
And no one even commented that the function of banks was to provide a service of looking after people’s money, the question was really how to ensure that the shareholders’ returns could be maintained.
And they all lived happily ever after.
THE END

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08/12/2024

Health Insurance Executive Targeted in New York

6 December 2024

A top health insurance executive was killed in what seems to be a targeted shooting in New York’. It seems that he was threatened over ‘health insurance issues’.
Every day I see patients who have their perfectly reasonable treatment requests refused by workers comp or CTP (Compulsory Third Party = Green Slip) insurers. The ‘case managers’ who are grandly titled case clerks have little power and follow protocols dictated by more senior folk in the organisati0on. I am unsure if they get bonuses for cases costing less than some statistical average for that type of claim, but nothing would surprise me. Sometimes it seems that they just refuse treatments because they think that they will get away with it, but the odds are stacked that they will often succeed anyway. The case clerks (Case ‘Managers’) cop a lot of abuse and are rotated frequently, perhaps to prevent their abuse or perhaps to prevent them getting to know their ‘clients’, who some of us would call ‘patients’. The case clerks have very little discretion and the system is very slow and seems designed to ensure that absolutely no one could ever be overpaid. The clerks follow their protocols, and are often unavailable and do not return calls. Most use their first names and a letter (presumably the first letter of their surnames) presumably so that they will not be personally targeted by those whose treatments they are refusing. (One would have thought that as people handing out money to people in distress that they might be very popular). It is as if one side are playing a game with money, but for the other side it is deadly serious.
Given that about a third of the population live from paycheck to paycheck, the fact that insurers have 3 weeks to accept or reject the whole claim, then 3 weeks to approve or deny any treatment, and longer if it is a difficult case, a huge amount of human misery can be created without even stressing any protocols. Governments are keen to keep premiums low and seem keen to support any insurer –suggested legislative amendments that achieves this aim. Interestingly the NSW Parliamentary Committee reviewing the NSW Workers Compensation legislation in 2022 had no input for either patients or doctors or their organisations. Presumably they did not seek such input and there was no publicity for the inquiry.
I see in my practice many distressed people whose lives are destroyed by these treatment denials. Now with the insurers only liable for the first 5 years after injury, if they can delay treatment longer than that, they are off the financial hook and the patients need to be treated by Medicare if that is possible. When I say ‘if that is possible’, many specialists will not do any Medicare work as it pays less than half the private rate. The waiting list is usually over a year for non-emergencies and the specialists are even more reluctant to treat cases that should have been paid by workers comp or CTP insurers. Even that assumes that the patients have Medicare; overseas students or people on working visas do not.
My belief is that insurers want to control medicine and the WC and CTP insurers, now with considerable input from the American Health insurance industry are preparing for the (very soon) day when Medicare is irrelevant and insurers tell doctors what they may do.

The patients whose lives are destroyed by the insurer denials of their reasonable treatments are upset and angry, often shattered physically and by the loss of their homes, properties and marriages do not think through how this has all happened. They are angry with the ‘case manager’ but not those higher up in the organisation who set the protocol that was the basis of their treatment denial.
Years ago, when I went to tobacco control conferences in the USA, there would sometimes be discussions among doctors about how to treat various medical conditions. Amongst the non-Americans, the talk was about what regimes were best. The Americans were usually concerned with what the insurers would pay for to the point that it was sometimes frustrating to have them in the conversations. I won a Fellowship in 1985 to study workplace absence and got some flavour of the way treatments were denied. I now see it all unrolling in Australia.
In the US guns are easy to get. When I saw a US health executive had been shot by an unknown person, I did not find it hard to find a motive, and thought that there could probably be a very large number of suspects. I Australia the case managers do not dare give their surnames, but the top executives are still all on the company websites.
If we continue to let Medicare be defunded because of private health donations to the major political parties and put money ahead of people’s reasonable needs, we will follow the Americans.

Here is the Reuters article in the SMH 6 December 2024

Health executive shot dead on New York street

Brian Thompson, the chief executive of UnitedHealth’s insurance unit, was fatally shot yesterday outside a Midtown Manhattan hotel in what appeared to be a targeted attack by a gunman, New York City police officials said.

The shooting occurred in the early morning outside the Hilton on Sixth Avenue, where the company’s annual investor conference was about to take place. Thompson was rushed to a nearby hospital where he was pronounced dead. The attacker remained at large, sparking a search that included police drones, helicopters and dogs.

“This does not appear to be a random act of violence,” New York City Police Commissioner Jessica Tisch said. “Every indication is that this was a premeditated, pre-planned, targeted attack.” The suspect, wearing a mask and carrying a backpack, fled on foot before mounting an electric bike and riding into Central Park, police said. Law enforcement authorities said the gunman appeared to use a silencer on his weapon, CNN reported.

UnitedHealth Group said Thompson was a respected colleague and friend to all who worked with him. “We are working closely with the New York Police Department and ask for your patience and understanding during this difficult time,” it said in a statement. “Our hearts go out to Brian’s family and all who were close to him.”

UnitedHealth Group is the largest US health insurer, providing benefits to tens of millions of Americans who pay more for healthcare than in any other country.
Video footage showed the gunman arrived outside the Hilton about five minutes be
fore Thompson. He ignored several other people walking by, NYPD Chief of Detectives, Joseph Kenny told reporters.

When Thompson approached the hotel, the gunman shot him in the back with a pistol and then continued firing, even after his gun appeared to jam. “Based on the evidence we have so far, it does appear that the victim was specifically targeted, but at this point, we do not know why,” Kenny said. The shooting happened not long before the scheduled investor conference at the Hilton.

UnitedHealth Group chief executive Andrew Witty took to the stage about an hour after the event started to announce the rest of the program would be cancelled.
“We’re dealing with a very serious medical situation with one of our team members, and as a result, I’m afraid we’re going to have to bring to a close the event today,” he said.

Police tape blocked off the area on 54th Street outside the Hilton, where blue plastic
gloves were strewn about, and plastic cups appeared to mark the location of bullet casings.
Thompson’s wife, Paulette Thompson, told NBC News that he told her “there were some people that had been threatening him”. She didn’t have details but suggested the threats may but suggested the threats may
have involved issues with insurance coverage. Eric Werner, the police chief in the Minneapolis suburb where Thompson lived, said his department had not received any reports of threats against the executive. The killing shook a part of New York that is normally quiet at that hour, about four blocks from where thousands of people were set to gather for the city’s Christmas tree lighting. Police promised extra security for the event.

“The police were here in seconds. It’s New York. It’s not normal here at seven in the morning, but it’s pretty scary,” said Christian Diaz, who said he heard the gunfire from the nearby University Club Hotel where he works.

Police issued a poster showing a surveillance image of the man pointing what appeared to be a gun and another image that appeared to show the same person riding on a bicycle. Minutes before the shooting he stopped at a nearby Starbucks, according to additional surveillance photos released by police. They offered a reward of up to $US10,000 ($15,500) for information leading to an arrest and conviction.

Governor Tim Walz of Minnesota, where the company is based, said the state was praying for Thompson’s family and the UnitedHealth team. “This is horrifying news and a terrible loss for the business and healthcare community in Minnesota,” he said in a statement. Thompson, a father of two sons, had been with UnitedHealth since 2004 and served as chief executive for more than three years. Thompson was appointed head of the company’s insurance group in April 2021 after working in several departments, according to the company’s website.

“Sometimes you meet a lot of fake people in these corporate environments. He certainly didn’t ever give me the impression of being one of them,” said Antonio Ciaccia, chief executive of healthcare research non-profit 46brooklyn, who knew Thompson. “He was a genuinely thoughtful and respectable guy.”
Reuters, AP

 

There was considerable follow up:

www.smh.com.au/world/north-america/bullets-used-in-us-healthcare-exec-s-killing-had-writing-on-them-20241206-p5kwa6.html

www.smh.com.au/world/north-america/wave-of-hate-flows-for-health-insurance-industry-after-ceo-s-shooting-death-20241206-p5kwcz.html

 

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26/11/2024

Social Media Ban misses the point- it’s about Algorithms

25 November 2024

Social media is not a fixed thing to be either accepted or banned.

I was surprised to find my son in favour of a ban, thinking it would stop communications between kids. He assured me that with groups able to be formed easily on WhatsApp, kids could still exchange whatever social relationships or information they liked.

It got me thinking about why social media might be harmful. Presumably kids can gang up more easily as they can all see what others write, just as minority groups can find and reinforce each other for good or ill. But this would also be a problem on WhatsApp.

The key point was one that I made a few posts ago. The object of social media is to keep people online so that they will see the advertising and make money for the social media owner. The way that this is done is to put people in touch with people like them or who believe things like them, particularly if their views are unusual. It is also helpful to upset or disturb people as while they are stimulated they will stay online.

The converse of this is that calming people down, or giving them sensible information has no financial advantage.

What viewers get in their feed is determined by algorithms, which are AI (Artificial Intelligence). These algorithms could be set to give good o]knowledge to anyone who asked for it or was open to it. Google searches often give a series of ads where someone paid to be the first thing found in the search, followed by a ‘top pops’ of replies or hits. It could rate the academic reliability of knowledge sources and give greater weight to more credible sources.

The same principles apply to social media. It is about what the object of the algorithm is, and thus what content it favours and directs.

Algorithms are of course ‘commercial in confidence’ which is code for ‘making money and therefore unable to be accessed or interfered with’. In other words, making money is more important than any social distortions or effects are merely tough luck for those affected.
But it seems to me that a more intelligent approach is needed to social media.

It’s about algorithms stupid!

www.change.org/p/oppose-australia-s-proposed-social-media-ban-for-under-16s

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21/07/2024

DVA Still Screwing Veterans

21 July 2021

 

A recent article shows that the Dept of Veteran Affairs is still making it hard for injured veterans to get redress.

 

This is entirely consistent with the way that governments try to minimise all welfare payments.

 

Centrelink is a bureaucratic nightmare. They will not pay until you have absolutely no resources, and the amounts are not enough even to pay rent in capital cities.  Morrison claimed that he had cut the rate of people being granted the Disability Support Pension by two thirds. All the people refused have to keep sending off job applications as part of their ‘mutual obligations’.  I see these people. They have virtually no hope of a job and are wasting their own and employers’ time.

 

I work in the State area of workers compensation and CTP injury. SIRA (State Insurance Regulatory Agency) is chiefly concerned that insurers do not pay out too much, so that the government can boast that premiums are low.  There’s not much danger of insurers overpaying. They refuse a large number of investigations and treatments that are standard elsewhere.

 

Veterans Affairs used to be a special welfare system for returned service personnel and was set up after the world wars as a system to look after heroes. But wars lately have been neither popular, nor in Australia’s interest. The Vietnam war was unpopular, as were the wars in Iraq and Afghanistan. Vietnam was a mistake, but the more recent ones were merely done to please the USA, who also should not have been there.  Our troops have lots of PTSD and because negative media coverage was stopped after Vietnam, the veterans cannot really talk about what happened to anyone who understands.  Their suicide rate has been high. But consistent with the lack of willingness for any sort of welfare, the veterans also have a bureaucratic nightmare, which delays payment as long as possible, often till their death by suicide.

 

The market-obsessed late capitalist system in which we live simply creates greater inequality, and the only way to maintain a harmonious social fabric will be to support disadvantaged people, whatever the cause of their disadvantage. It has been said that the Left tries to lessen inequality and the populist Right tries to defend privilege or finds scapegoats. As we watch the US unravel or see our government and opposition blame migrants for the housing shortage it is hard to argue with this proposition.

 

In the meantime, the veterans need help against the government’s lawyers. And the population should try to stop us being drawn into very silly wars.  Taiwan looks like the next danger.

 

Royal Commission into Veteran Suicide confronts lawfare, cronyism and a bureaucratic nightmare

 

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02/06/2024

Science Starts to Respond to the Legal System

2 June 2024

Scientists and others, like doctors, who are of a scientific bent have for years despaired of the legal system whose practitioners seem to have little respect for knowledge other than their own and accept very poor scientific evidence.  Now the high-profile head of the Australian Academy of Science, Prof Anna-Maria Arabia, who gave evidence in the Folbigg case has hit back.  Kathleen Folbigg was accused of killing 3 of her children, but later scientific evidence showed that they had a genetic defect.  Prof Arabia is looking at the relationship between science and the law and wants to put a bit more discipline into the science-law relationship. All power to her arm!

‘It could be any of us’: Top scientists sound alarm over unreliable evidence

By Michael Bachelard, Nick McKenzie and Ruby Schwartz

Sydney Morning Herald   June 2, 2024 — 8.00pm

Australia’s peak science body has called the triple-murder conviction of Robert Farquharson for driving his sons into a dam in 2005 into question, saying it was partly based on unreliable scientific evidence and his case would be ripe for review if the nation had a mechanism to reconsider old convictions.

Farquharson is serving a 33-year prison sentence in the protection unit of Victoria’s Barwon Prison after being twice found guilty of murdering his three children by driving them into a dam on Father’s Day in 2005, and with an appeal court affirming his guilt. But a number of legal and scientific experts have questioned the evidence that convicted him.

Australian Academy of Science chief executive Anna-Maria Arabia said, speaking generally, that courts were susceptible to “junk science” being admitted and that cases such as Farquharson’s demonstrated the need for significant legal reforms to try to prevent the use of unreliable evidence.

“Every member of the public should be concerned about a justice system that is not adequately informed by science. Any one of us could be Robert Farquharson,” she told this masthead and 60 Minutes.

Arabia said cases such as Farquharson’s, and the recent release of Kathleen Folbigg, who spent 20 years in prison for murdering her three children and manslaughter of the fourth, showed that expert scientific witnesses should be independently selected based on their expertise, and that the evidence they give should be proved reliable before a jury could hear it.

She also called for a review mechanism that sits alongside the court system to look at possible miscarriages of justice.

“The system ought to be more robust than it is. And it can be. It can be reformed. It takes some political will; it takes some courage,” she said.

Arabia said she had serious concerns about a number of the “strands” of the scientific and circumstantial evidence used to convict Farquharson. Among her concerns were the quality of the medical and traffic reconstruction evidence that convinced two juries and an appeal court of his guilt.

Farquharson told police he coughed and passed out in the lead up to the crash – a condition called cough syncope – which meant he was unconscious when his car drove into the dam.

Lawyers for Farquharson have flagged a new appeal later this year, under a Victorian law introduced in 2019 that allows prisoners to present “fresh and compelling evidence” to the court where a conviction constitutes a substantial miscarriage of justice.

Farquharson’s lawyer, Luke McMahon, said this was a high legal bar which “places the onus back on the accused”, and was “not really an examination of how things unfolded”. Since the convicted person is often in prison, the appeal mechanism also often requires lawyers to work pro bono, or without pay, to take on cases.

Arabia said that “in the vast majority of cases, that is not enough” to address problematic cases.

The Academy of Science has called for a standing tribunal like those in New Zealand, the United Kingdom and Norway, which employ dedicated staff to identify and investigate possible miscarriages of justice. Known as a Criminal Cases Review Commission in the UK and New Zealand, these bodies can examine cases where there are developments in scientific or other evidence, then refer them, with advice, back to the courts or the government.

Asked if the Farquharson case would be a lead candidate for such a tribunal, Arabia said the medical evidence of cough syncope “would be considered new evidence that should be assessed by something like a Criminal Cases Review Commission to see if it meets a threshold to reopen and re-examine this case.

“It should not be beyond the realm of possibilities to establish a criminal case review commission in Australia and to resource it adequately. After all, this enables the delivery of justice to the Australian people. It should be a bare minimum requirement as part of our justice system,” she said. “Australia really is an outlier in this area.”

Police involved in the Farquharson case declined interviews, but Assistant Commissioner Glenn Weir said in a statement that Victoria Police “stands behind the rigorous investigation which led to the 2010 conviction of Robert Farquharson”.

“We consider this matter finalised and will not be commenting further. In the event of any appeal by Farquharson, we will respond as required,” he said.

A recent book by Stephen Cordner, the head of international programs at the Victorian Institute of Forensic Medicine, and retired physician Kerry Breen, said the UK case review commission had referred 657 cases to the court of appeal over 22 years, with 441 convictions quashed.

Translated to Australia, that would mean eight or nine wrongful convictions a year, they wrote in their book, Wrongful Convictions in Australia.

In the United States, the Innocence Project had overturned more than 350 cases. False confessions, inaccurate eyewitness evidence, misleading forensic evidence, police misconduct and bad defence were key errors, they wrote.

Arabia has also called for changes to the treatment of expert evidence. Currently, people accepted as experts can give their opinions in court based on their knowledge, but they are selected by the parties – prosecution and defence – and are not always the most qualified people, Arabia said.

“How do we get the right experts before our judges and juries, selected for the right reasons, not … because they’re good presenters in court, but because they are the best possible expert who has the best available knowledge?” Arabia said.

The Academy of Science also wants a “reliability standard”, so that courts do not admit expert evidence unless it can be demonstrated that it is reliable.

In the absence of such a standard, Arabia said, “pseudoscience and junk science can be admitted into court, and juries and judges will consider that as part of their deliberations. I think most people would … be shocked by that.”

Arabia said accomplished scientific experts often did not want to give evidence in courts because “it is such a hyper-adversarial situation, and what ends up happening is that those experts are asked about matters that are well beyond their area of expertise.

“We have scientists who come to the Australian Academy of Science, having been expert witnesses in a case, thinking they’re doing the right thing, who have felt so cornered or manipulated in that process that they will never do it again,” she said.

“What a great loss for our justice system, that some of the most reliable and best minds in our country feel that that is a forum where they can’t present their best, their knowledge.”

Arabia said reform would require attorneys-general at the state and federal levels to “roll up their sleeves and commit to looking at improving the systems so that they can deliver justice for everyone equally”.

Victorian Attorney-General Jaclyn Symes declined requests for an interview on the academy’s proposals. In a statement, a departmental spokesperson said: “Victoria’s justice system has processes in place to ensure the quality and reliability of forensic evidence presented in court.”

The government was monitoring the effectiveness of these processes, the statement said, and was “reviewing any opportunities for improvement, including discussions with other states and jurisdictions”.

NSW Attorney-General Michael Daley’s spokesperson said there were “existing mechanisms in place” to allow the state’s courts to consider scientific evidence and also for “ad hoc inquiries into convictions, as occurred with the 2022 Folbigg Inquiry”. The state’s experts code of conduct said their “paramount duty is to assist the court impartially”.

Federal Attorney-General Mark Dreyfus declined to comment.

Arabia said courts were doing their best, but advances in science made it difficult to be across all the detail.

In the Farquharson case, Arabia said she was concerned by medical evidence about cough syncope which painted the condition as “extremely rare”, and the traffic reconstruction evidence, in which police experts said the car was subject to three conscious steering inputs by the driver, who therefore could not have been unconscious.

She said there were also questions about the memory evidence of two key witnesses. One, Dawn Waite, did not come forward until four years after Farquharson drove into the dam. Another witness, Greg King, told how his memory of a conversation incorporated more features over time of events that had subsequently occurred.

“We know scientifically that memory evidence is quite unreliable. And memory can be open to change based on external stimuli, things like media reporting, things like discussion, things like looking at photos, dreams,” Arabia said.

Victorian Criminal Bar Association vice chairman Jason Gullaci, SC, said most lawyers would welcome another layer of review from a criminal cases review commission.

“It’s an excellent idea. And I think it’s got real merit,” Gullaci said. “Where there are advances in science that then call into question previous expertise and opinions that were thought to be valid, but that if it has had a significant impact on a trial and conviction and is likely [to have] caused a miscarriage of justice, I think the criminal lawyers would want that rectified, whichever side of the fence they stand on.”

 

This article was at www.smh.com.au/national/victoria/it-could-be-any-of-us-top-scientists-sound-alarm-over-unreliable-evidence-20240528-p5jh7q.html

Watch the 60 Minutes special episode here. https://www.9now.com.au/60-minutes/season-2024/episode-18

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17/03/2024

The Australia Card and Data

16 March 2024

The Australia Card debate, which was from 1985-7 was whether we should all carry a card that would link all the information about us.

I was in favour of it because my concerns at that time in occupational health and safety was as to whether exposure to various workplace chemicals had an adverse effect on health.

The best data came from Sweden, where people’s occupation was on a database and their mortalities could be compared. Nowhere else had comparable data.

It seemed to me that the data was going to be collected inevitably and we should have a debate then and there as to who would collect it and what could be done with it.

I was in the Australian Democrats, who were usually quite sensible and given to rational argument, but the view was that people would be safer if the data was not collected at all so they opposed the card and the naysayers won the day in the Party and the nation.

The Credit Reference Association was already collecting data about unpaid bills and there was a debate as to whether the subject of the data, (who was usually only alerted to its existence when they could not get a loan), could have access to their own record to respond with reasons for whatever was on it.

Naturally financial data was of use to the tax office and now buying habits, web-search histories and emails result in changes to the feed of ads on social media.

Now that financial data is collected, the discussion can move on to more socially helpful data.  Apparently Facebook can announce a flu epidemic earlier than the public register of viral tests or hospital admissions just from reading the frequency of the words ‘flu or sick’ on the posts.

In life I have progressed from dealing with acute diseases in heroic medicine and  intensive care settings to looking at how to do prevention. Prevention is always the poor cousin, because if you spend money on it is hard to show results in the short time frame that accountants and politicians want.

As I moved from medicine to social policy and tried to advocate for ‘preventive social policy’ the situation became even more difficult, despite the well known fact that increasingly social disadvantage gives rise to poorer health outcomes. This is acknowledged with lip service, but the late-stage capitalist growth in inequality powers on regardless.

In 2001 as a NSW MLC I initiated an inquiry into DoCS (Dept of Community Services), which was then called FACS (Family and Community Services), and is now called DCJ (Dept of Communities and Justice).  My inquiry showed that the Dept was dysfunctional, which we knew already, and the changes since have not helped much. Initially the problem was that they wanted to concentrate on the children most at risk, which meant still minimal supportive prevention for cases that were not at risk yet.  Then the Department became even more defensive and privatised cases, so the kids became a commodity with NGO and ‘for profit’ corporations getting packages to look after kids with problems and then giving them to carer families for about a third of the money that they were given.  ‘Management’, it seems, is a very expensive and lucrative business.

Obviously looking after kids whose parents are dysfunctional is a very difficult undertaking.  Does one take the child and give it a good foster care family?  What is a good foster care family? How much do you support dysfunctional parents?  Are the grandparents, who presumably brought up the dysfunctional parents a good bet? Who makes the decision and what appeal mechanisms are there?  Presumably all this is rendered ever more difficult by the fact that the gap between rich and poor is rising, there is no longer anywhere near enough public housing, and welfare payments are not really enough to live on.

It seems that the best way to see what policy works is to follow the kids in a lifetime study and see how they turn out. The criticism is that the OOHC (Out of Home Care) system has a hugely higher percentage of kids graduating to juvenile justice and then adult prisons.  But data is hard to get as the Department, despite its numerous renamings, will not release the information as it is politically embarrassing.  Naturally the privacy of the children is cited, but the data could easily be de-identified as much epidemiological data is.

We need to get data to make better decisions, ones based on facts as far as possible, with transparent assessment procedures with honest assessments of what is happening and a minimum of political or bureaucratic interference. With ‘issues management’ aka PR BS getting more sophisticated all the time, it will be an increasing struggle.  The Aust Bureau of Statistics, which tries to produce facts, but can only work with the data it is given and presumably cannot be political in trying to get better data, was significantly defunded by Tony Abbott as part of his war on facts. Meanwhile the private sector hoovers up personal data and a few diehards try to keep using cash.

Ross Gittins, the SMH Economic Editor who generally writes good commonsense in a digestible form and has recently been recognised for his good work, has penned the article below in today’s SMH.

Australia Card anyone?

 

How the digital world is getting better at measuring us up

Ross Gittins, Economics Editor

SMH March 15, 2024

These days we hear incessantly about “data”. The media is full of reports of new data about this or that, and there’s a new and growing occupation of data analysts and even data scientists. So, what is data, where does it come from, what are people doing with it, and why should I care?

Google “data” and you find it’s “facts and statistics collected together for reference or analysis”. The advent of computers has allowed businesses and governments to record, calculate, play with and store huge amounts of data.

Businesses have data about what goods and services they’re making, buying and selling, importing or exporting, and paying their workers, going back for 30 or 40 years.

Our banks have data about what we earn and what we spend it on, especially when we use a credit or debit card – or our phone – to pay for something.

Much of this data is required to be supplied to government agencies. If you ever go onto the Australia Taxation Office’s website to do your annual tax return, it will offer to “pre-fill” your return with stuff it already knows about your income from wages, bank interest and dividends.

Try it sometime. You’ll be amazed by how much the taxman knows and how accurate his data are.

Another dimension of the “information revolution” is how advances in international telecommunications – including via satellites – have allowed us to be in touch with people and institutions around the world in real-time via email and the web – news, entertainment, social media, whatever.

Last month, the Australian Statistician – aka the boss of the Australian Bureau of Statistics – Dr David Gruen, gave a speech outlining some of the ways these huge banks of “big data” about the economic activities of the nation’s businesses, workers, consumers and governments can be used to improve the way we measure the economy in all its aspects: employment, inflation, gross domestic product and the rest.

We’re getting more information and more accurate information, and we’re getting it much sooner than we used to. But we’re still in the early days of exploiting this opportunity to be better informed about what’s happening in the economy and to have better information to guide the government’s decisions about its policies to improve the economy’s performance.

Gruen starts by describing the Tax Office’s “single-touch” payroll system, software that automatically receives information about employees’ payments every time an employer runs its payroll program.

Not all employers have the software, but those who do account for more than 10 million of our 14 million employees.

Gruen says the arrival of the pandemic in early 2020 made access to this “rich vein of near real-time information” an urgent priority. The taxman pulled out the stops, and the stats bureau began receiving these data in early April 2020.

With a virus spreading through the land and governments ordering lockdowns and border closures, they couldn’t afford to wait a month or more to find out what was happening in the economy. Thus, the whole project of using big data to help measure the economy received an enormous kick along – here and in all the other rich economies.

So, in addition to the longstanding monthly sample survey of the labour force, we now have a new publication: Weekly Payroll Jobs and Wages Australia. These data allowed the “econocrats”—and the rest of us—to chart the dramatic collapse in jobs across the economy over the three weeks from mid-March 2020.

They show employment in the accommodation and food services industry falling by more than a quarter in just three weeks. Employment in the arts and recreation services industry fell by almost 20 per cent. By contrast, falls in utilities and education and training were minor.

The monthly labour force survey has a sample size of about 50,000 people, compared with the payroll program’s 10 million-plus people, meaning it provides information on far more dimensions of the workforce than the old way does.

So, the bureau’s access to payroll data taught it new ways of doing things. And the pandemic increased econocrats’ appetite for more info about the economy that was available in real-time.

With household consumption – consumer spending – accounting for about half of gross domestic product, improving the timeliness and detail of the data was a great idea.

So, in February 2022, the bureau released the first monthly household spending indicator using (note this) aggregated and de-identified data on credit and debit card transactions supplied by the major banks. This indicator provides two-thirds coverage of household consumption, compared with the less than one-third coverage provided by the usual survey of retail trade.

The bureau has also begun publishing a monthly consumer price index in addition to the usual quarterly index. This is possible because big data – in the form of data from scanners at checkout counters and data scraped from the websites of supermarket chains – is much cheaper to gather than the old way.

The bureau has also started integrating different but related sets of big data from several sources, so analysts can study the behaviour of individual consumers or businesses. It has developed two large integrated data assets.

The one for individuals links families and households with data sets on income and taxation, social support, education, health, migrants and disability.

The one for businesses links them with a host of surveys of aspects of business activity, income and taxation, overseas trade, intellectual property and insolvency.

The purpose is to allow analysts from government departments, universities or think tanks to shed light on policy problems from multiple dimensions.

For instance, one study showed that people over 65 who’d had their third COVID vaccination within the previous three months were 93 per cent less likely to die from the virus than an unvaccinated person. But that’s just the tiniest example of what we’ll be able to find out.

 

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16/02/2024

‘Health Policy’

Chesterfield-Evans, A. (2024)

Journal of Australian Political Economy  No. 92, pp. 98-105.

HEALTH POLICY
Arthur Chesterfield-Evans

Just before the 2022 federal election, Mark Butler, now the Minister for
Health in the Albanese government, spoke to the National Press Club,
praising the courage of the Hawke government in creating Medicare in
1984. His speech also set modest priorities for a prospective Labor
government, committing to (1) improve the digital health record and make
the MyHealth record actually useful; (2) develop multidisciplinary care;
(3) establish a new funding model for ‘MyMedicare’; and (4) grow the
medical workforce, with special mention of nurses and pharmacists (Butler
2022). Significantly, Butler did not commit afresh to Medicare as a
universal health scheme free at the point of delivery, the key element of
the original 1984 scheme that he praised. In an environment where,
politically, it seems that taxes cannot be increased, perhaps this ideal may
be an impossibility, but it is surely significant that it is no longer stated as
an aspiration.
Currently, Medicare is quietly dying as the low rebates cause doctors to
abandon it. Australia is moving to a US-type private system by
default. This has resulted in large amounts of hand-wringing rhetoric, but
so far little action. This short article comments on the changes initiated by
the current Labor government during its first year and a half, contrasting
these with the deep-seated problems needing to be addressed if better
health outcomes are to be achieved.
Labor’s reforms
The government has made some minor changes to Medicare which came
in with great fanfare on November 1, 2023. There were new item numbers

for new specialist technologies or treatments and an increased Medicare
rebate for GPs, up to $41.40 for a standard visit for a RACGP member,
which is 40.6% of the AMA fee. Doctors without the RACGP qualification
still get $21, which is 20.6% of the $102 AMA fee.
When Medicare was born, the Medicare rebate was 85% of the AMA fee.
The rebate has risen at half the inflation rate for 39 years, so doctors now
feel ripped off every time they see a Medicare patient. Labor blames the
disparity on the rebate freezes of the previous LNP Coalition governments,
but its own record is poor. Successive governments of all types have
deferred to the private health lobby and are starving Medicare, slowly
defaulting towards a principally private system, as in the USA. This is a
deeply-troubling prospect because the US health system has been
recurrently criticised (Commonwealth Fund 2021) – and rightly so –
because it makes access to health care dependent on ability to pay. Notably,
however, it is the world’s best system at turning sickness into money.
The other recent Labor ‘reform’ was to allow pharmacists to process
prescribed medications to cover patients’ requirements for 60 days, rather
than 30 days, thereby halving the costs of prescribing and dispensing.
While this may seem helpful, patients are often confused by complicated
generic names and generic brands; and compliance or discontinuation of
medicines is a largely unquantified problem. These are existing problems
with the current arrangements for dispensing medications: the recent
policy change, while well-intentioned, does not redress them. It transfers
resources from professional staff to the pharmaceutical industry.
The ‘Strengthening Medicare Taskforce’ had good medical and allied
health representatives and support. Its December 2022 report defined the
problems but, trying to avoid controversy, positive suggestions were thin
on the ground. A deeper analysis and more comprehensive approach to the
redress of health issues is needed.
Basic problems in the health system
Diverse funding sources causes cost-shifting
Fundamentally, no-one is in overall control of the health system. It has a
number of different funding sources: the Federal and State governments,
the Private Health Insurance industry (PHI), Medicare and individuals

themselves. Workers Compensation (WC) and Compulsory Third Party
(CTP) insurers also put in a bit. These arrangements lead to a situation
where each funding entity attempts to shift costs without any real care for
the overall cost of the system. Private entities such as pathology and
radiology also have an interest in providing more services, whether they
are needed or not.
The broad division of the health system is that public hospitals and
emergency departments (EDs) are State-funded, and non-hospital services
are Federally, PHI or self (patient) funded. There is some overlap,
however, because the State’s provision of some community-based services
allows them to save on hospital-bed days; and private funds paid to State
hospital in-patients are eagerly sought. The starvation of Medicare (which
reduces the Federal government’s spending) has resulted in more patients
going to EDs at higher (State) cost, as well as increasing PHI and patient
costs.
This cost-shifting has evident implications for the affordability of health
care: notably, a recent study showed that Australia, when compared to 10
other countries, scored poorly on its measure of affordability
(Commonwealth Fund 2021).


A new health paradigm is needed
Yet more fundamentally, there is a huge problem with the conceptual
model of the health system. In common parlance, the ‘health system’ is the
‘paying to treat illness’ system. Paying doctors to see and treat patients is
seen as the major cost and is the most politically fraught element in the
system.
Historically, everyone was assumed to be healthy and had episodes of
either infectious diseases or surgical problems. They went into a hospital
for a brief period and either recovered or died. The legacy of this is that
heroic interventions are over-resourced and the more cost-effective early
interventions are under-resourced.
Infectious disease is now relatively uncommon, notwithstanding the recent
and ongoing coronavirus concerns. Most disease is chronic; and the
objective is to maintain health for as long as possible and to support those
who need support in the community rather than in institutions. ‘Health’
must be re-defined as a state of physical and mental wellbeing; and
maintaining it as ‘demand management’ for the treatment system.

Life-style diseases of diet, obesity, smoking, vaping, alcohol, drug-use and
lack of exercise need attention. It might be commented that these habits
are more determined by the political economy of the products than by any
health considerations; and the government should intervene to re-balance
this market failure.


Hierarchies, cartels and corporatisation
The medical system is hierarchical with specialists at the top and GPs at
the bottom. The specialist colleges have produced less practitioners than
would have been optimal. The starvation of General Practice has led to
increasing specialist referrals for simple procedures. Most patients are
happy to go along with this, though often much less happy about the rising
costs. Practitioners tend to work down to their station rather than up to
their capacity. GPs, if given the appropriate additional education and
empowered to act, could do what quite a lot of specialists do now, while
nurses could take the load from GPs; and, in terms of home support, a more
comprehensive and flexible workforce needs to be developed.
Private medical insurance systems are a further source of problems. They
have marketing, churn, profits, liability and fraud issues; and they make it
necessary to account for every item of every procedure. While the
corporations watch every cost, the regulator cannot. Corporations buy
medical practices and take up to 55% of the gross revenue. Smaller
radiology practices are being gobbled up as investments (Cranston 2020).
If overheads are defined as the amount of money put in compared to the
amount paid for treatments, Medicare costs about 5% and PHIs, as they
are regulated in Australia, about 12%. In the USA, the private health funds
take up to 35%, and Australia’s CTP system got close to 50%. A universal
health insurance system could avoid many of these costs and would be far
superior from a social equity point of view.
Similar problems are evident in the provision of care for people with
disabilities. Labor pioneered the NDIS when last in office a decade ago,
and rightly claims this as evidence of its commitment to redress the
previous neglect. However, the NDIS can be considered as a privatisation
of the welfare system. It overlaps medical system functions and is poorly
regulated. If its efficiency is judged by the percentage of money put in that
is paid to the actual workers delivering the service, care is not very

efficient. There have also been significant criminal rip-offs (Galloway
2023).
Retirement care arrangements have major flaws too. Aged-care
accommodation is largely driven by the real estate industry; and access to
continuing care is an add-on of often dubious quality.

What should the government do?
The problems described above are diverse, deep-seated and not easily
rectified. However, a government intent on staying in office for a series of
terms could heed the call for some big thinking, drawing on the experience
of health practitioners themselves. Here is a list of what might be done,
becoming more medical and more politically difficult as it progresses:
• Keep people healthy with education, clean water, sanitation, housing,
good food, regular exercise, high vaccination rates, road safety,
universal swimming lessons, CPR and first aid training and the active
discouragement of smoking, vaping, alcohol and drug use, junk food
and gambling.
• Provide housing with graded community support options for those
people with disadvantage or impairment. Create a registration and
insurance system for home and community support services, so that
individuals can buy standardised services from other individuals.
• Maintain fixed staff-patient ratios related to the disability
classification of residents in institutional care.
• Make maximum use of community and school interventions and
support services such as District and Community nurses and School
nurses, mental health support networks, Aged Care Assessment
Teams, Hospitals in the Home etc.
• Address health problems as early and as low down the support and
treatment hierarchy as possible, by empowering those who provide
the services.
• Create a meaningful regulatory, inspection and enforcement system
for support services, both community and residential, and for
workplaces and recreational facilities.
• Use the medical information system to research drug and treatment
effectiveness.
• Support General Practitioners and try to increase their ability to solve
problems without referral. Have GPs work in Health Centres with
community support workers as far as possible; and improve
communication with data collection a by-product of normal work, not
an additional imposition.
• Have independent evaluation of the numbers needed in the specialties
and pressure the colleges to provide these numbers. Use waiting times
as an initial index.
• Initiate either university-based or college-based continuing medical or
professional education, with mandatory refresher exams every
decade.
• Have universal professional indemnity insurance, with doctors and
other health professionals unable to be sued if they report all incidents
of sub-optimal outcomes within 48 hours of becoming aware of them,
and participate in regular quality control meetings.
• Publicise and promote organ donation, end of life plans, wills and
enduring powers of attorney as sensible steps in life-management.
• Evaluate Intensive Care interventions in QALY (Quality-Adjusted
Life Years) terms, researching their outcomes and comparing them to
earlier intervention initiatives.
• Change the composition of the Pharmaceutical Benefits Advisory
Committee so that it has no pharmaceutical industry representative on
it; and remove ministerial discretion from its decisions. The previous
system evaluated new drug listing approvals with a cost-benefit
analysis (Doran et al. 2008), but the Howard reforms of 2007,
following the Australia-US Free Trade Agreement and lobbying by
Pfizer, put a drug industry representative on this committee, making
its negotiations more transparent and thus more difficult for the PBS
to negotiate prices (Access to Medicine Working Group 2007).
• Work towards replacing Workers Compensation and CTP insurance
schemes with income guarantee schemes (this will only be possible
when Medicare allows timely treatment).
• Create a credible and indexed scheme for paying medical
professionals which does not have KPIs that distort performance.
• Make Medicare a universal taxpayer funded health system that is free
at the point of delivery and stop subsidising PHI. It might be noted
that the Government currently quotes Medicare and PHI costs
together as a sum rather than itemising the two, which serves to
disguise the subsidy to PHI (Parliament of Australia 2022).
Conclusion
The current federal Labor government has made statements about health
policy reform and done minor tinkering during the first year and a half in
office. Based on this start, it is doubtful that it will have the courage to
make the necessary major changes, addressing the systemic problems.
Fine rhetoric is unlikely to achieve much. That makes it doubly important
to develop proposals for more fundamental reform. Written with this
intention, the suggestions made in this article could be the basis for
tackling the fundamental institutional and political economic issues
problems associated with personal and societal ill-health.
Dr Arthur Chesterfield-Evans trained as a surgeon in Sydney and the UK
and is a Fellow of the Royal College of Surgeons. He currently works as a
GP with interests in workers’ compensation and third-party injury. He has
been a tobacco activist and an elected member of the upper house of the
NSW Parliament. He has Master’s degrees in Occupational Health and in
Political Economy.
chesterfieldevans@gmail.com

References
Butler, M. (2022) ‘Address to National Press Club, 2 May,’ available:
www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-
care-speech-national-press-club-2-may-2023.
Commonwealth Fund (2021) US Report, available:
www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-
reflecting-poorly.
Cranston, M. (2020) ‘Radiology enjoys a post-virus buying boom’, Australian Financial
Review, available: www.afr.com/policy/economy/radiology-enjoys-a-post-virus-buying-
boom-20201106-p56c7k.
Doran, E., Henry, D., Faunce, T.A. and Searles, A. (2008) ‘Australian pharmaceuticals policy
and the idea of innovation’, Journal of Australian Political Economy, 62, pp. 39-60.
Galloway, A. (2023) ‘Federal crime syndicates using cash vouchers and gifts to steal NDIS
funds’, The Sydney Morning Herald, available: www.smh.com.au/politics/federal/criminal-
syndicates-using-cash-vouchers-and-gifts-to-steal-ndis-funds-20230414-p5d0ma.html.
Parliamentary Library (2022) Health overview, available:
www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/p
ubs/rp/BudgetReview202223/HealthOverview.
PBS (2007) ‘Access to medicines working group’, available: www.pbs.gov.au/info Access to
Medicines /general/working-groups/amwg/amwg-jul-2007.
Sax, S. (1984) A Strife of Interests: Politics and Policies in Australian Health Services,
Sydney: George Allen and Unwin.
Searles, A., Jefferys, S., Doran, E. and Henry D.A. (2007) ‘Reference pricing, generic drugs
and proposed changes to the Pharmaceutical Benefits Scheme’, Medical Journal of Australia,
187(4), pp. 236-39.
Strengthening Medicare Taskforce (2022) Taskforce Report, Commonwealth Department of
Health, available: www.health.gov.au/sites/default/files/2023-02/strengthening-medicare-taskforce-report_0.pdf.
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