Doctor and activist


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Tag: Privatisation

A Look at the NDIS (National Disability Insurance System)

14 April 2021

The whole model of the NDIS is wrong. It is all about turning care into a commodity for private profit. The con was that the people with disabilities would have ‘choice’ and could buy services from a range of providers, who would compete to give great service. But there are big structural faults.

Firstly, big corporations want big profits, so this creates an overhead so there is less money available.

Secondly, people are assessed by ‘experts’ so how much money you get based on a single interview. They are not people who actually do the job and could allocate compare the needs of different people in an area. The assessors are an overhead- another layer of managers.

Thirdly, once the money is allocated, those who have it will be encouraged to spend it whether they need it or not. And of course, this will favour those who present well (usually the middle class) and totally disfavour those who did not get a ‘package’.

Fourthly, the ‘market’ model does not work. Those who need the services do not necessarily know who can give them what they need. They are vulnerable to sales pitches from a limited number of providers and they may not even know about other options. In some geographical areas there may be only one provider, so there is no competition anyway; the provider can set the price and the profit.

Finally, the government can just lessen the amount of money and packages available.

When I was in a Parliamentary Committee looking at disability, the first thing we tried to find out what how many people were disabled. No one had wanted to keep records.  People who had tried to get services from a provider and been knocked back because there were no places assumed that there would be a list there and if a place came up they would be offered it. Wrong. Usually there was no list, and a new person got the place if they happened to know someone or turn up at the right time. But at a broader level, experts we asked about how much disability there was either told us how many people were on various schemes and tallied these up, or looked at AIHW (Aust. Institute of Health and Welfare) figures, which said what percentage of the population had a disability and multiplied this by the population. The second method gave figures that were about 10x the people on benefits. So it was very obvious that if there was a supposedly universally available system the cost was going to blow out enormously because of the unrecognised demand.

The solution in my view was to have a universal support system that was community-based, like a district nurse model, and then ask the people actually doing the job, who needed more, and who could be helped to get their own home help from a number of people who would be registered in classes of carers. The government would then buy services in response to the needs identified and quantified by those doing the job. The essence of this was the empowerment of those actually doing the job. NDIS actually does the opposite. It is about the government shovelling money to the private sector with some middle ranking experts supposedly swooping in and saying how much money is needed. If they were embedded in the service delivery framework, they would be discussing needs and relative needs with those actually delivering services.  

But modern management and politics assumes it knows best and those at the bottom need to be ‘managed’, i.e. told what to do. My experience is that people doing a job usually know more about it than anyone else and the intelligent use of their expertise is the most solid base for management. My experience is also that putting people in charge who are there for the money rather than the job are unlikely to do a better job than those who are more concerned with the job than the money.

I put this in a paper to Kevin Rudd’s’ 2020 Vision’ in 2000, but never even got an acknowledgement. The NDIS, like the Aged Care Act of John Howard seems to have used ‘choice’ as a Trojan Horse for a market model and privatisation.  We need to start again.  This is just a suggestion of a better model, but given the power of money in politics I am not hopeful of change.

A new article in The Saturday Paper 10/4/21 looking at the cost blowout and blaming those who need the services has a depressingly familiar ring.  The blowout was eminently predictable and cost control by victim-blaming at the bottom is more likely than looking for corporate rip-offs at the top.  This is what I see every day in Workers Compensation and CTP insurance.

www.thesaturdaypaper.com.au/news/politics/2021/04/13/exclusive-documents-leaked-secretive-ndis-taskforce/161829180011445#mtr

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Murray-Darling Farce- Another Summit.

19 March 2021

One of the more absurd ideas of neo-liberalism was to privatise ownership of all the water in the Murray-Darling and then rely on ‘the Market’ to allocate the water optimally. All that happened was that water was another commodity to be traded with its price more related to its possible future price than any physical or environmental constraint.

I learned a bit about this many years ago from my grandparents. One of my grandfathers was a retired metallurgist who would tell me about world trends in metal demands and buy shares accordingly. His wife, my grandmother, knew nothing about this but would buy shares based on what the market was doing and tell me separately about how she despaired of my grandfather’s share investments. After a few years, she was much richer than he from a much lower base. The moral was that the share price had little to do with reality.

Why anyone would think that turning water into a speculative commodity would optimise its use is beyond understanding. But that was what happened. Joh Bjelke-Peterson built Cubby dam on the Queensland border and used the water to irrigate cotton, so NSW was behind the 8 ball from the start. NSW cotton farmers used surface water and took water from aquifers with no supervision of their meters. Brokers with mobile phones bought and sold water entitlements, and famously recently a Singapore-based company sold a lot of water rights to a Canadian superannuation fund, who felt that growing almonds (which are heavy water users) would be a good thing to do. (SMH 3/12/19) Hey, the price of almonds is good at present and you cannot smell rotting fish from Canada.

The idea that if you fix the money, everything else will come right seems to permeate every aspect of our neo-liberal, managerial society. I think of it as a religion, that ‘the market knows best and will allocate optimally with the unseen hand’. It also seems that religious folk are more prone to believe this, happier to believe that an unseen force can magically fix things and that it morally worthy to suffer now for some future redemption.

But in politics, we do not even have to debate these things; there is another option, ‘kick the can down the road’. Having the CSIRO produce a report in 2008, ‘Water Availability in the Murray Darling Basin’, led to an inappropriate Murray-Darling Basin Authority report in 2009. The CSIRO’s scientific response in 2011 was ignored. There was a Royal Commission inquiry by Bret Walker which found that the Authority has shown ‘gross negligence’. So they had another ‘Summit’, just last month.

All this is not to mention that Angus Taylor spent $80 million in taxpayer money to buy back water rights from a company called Eastern Australian Agriculture registered in the Cayman Islands and run by an ex-rowing mate, with the deal signed off by Barnaby Joyce. (The Guardian 19/5/19)


It is a worry, when the senior counsel assisting Walker inquiry writes a book called ‘Dead in the Water’ and still comes back with an opinion piece like this.

www.smh.com.au/national/murray-darling-basin-summit-a-laughable-response-to-finding-of-gross-negligence-20210318-p57brq.html

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Mutual Obligation and ‘Noblesse Oblige’

18 March 2021

‘Mutual Obligation’ is the new buzz word for unemployed people.  If they are to get ‘welfare’ they have to be trying to get a job.   An index of this is to make a lot of job applications, that surely must be the bane of every employer in the land, with an obligation of job seekers to apply for 20 jobs a month and about 8 job seekers for every vacancy.

‘Noblesse Oblige’  is a French term dating from when English royalty spoke French after the Norman conquest (of 1066)  and refers to the benevolent, honourable behaviour considered to be the responsibility of persons of high birth or rank.  The term is so quaint and medieval that is often used ironically. But these days with the growing gap between rich and poor, and the lack of sanction on poor behaviour by the empowered class, it may be that old fashioned ethics is all that remains to help poorer people. And they are in short supply.

If there were mutual obligation, a government would be obliged to give its citizens a decent life.  In the 1950 and 1960s it was considered a government responsibility to get everyone a job and governments fell if the unemployment rate was over 1%.  In the 1980s when I worked at Sydney Water, it ran employment programmes for ex-prisoners, people who had been unemployed for more than 3 months, and people with disability.  The employment was for a 6 month term, and my job was to check that applicants were physically able to do the job.  There was a programme to separate sewage and rainwater in inner city areas and a pipe replacement programme.  Both of these programmes were simply canned.  The Apprentice School, which had about 180 apprentices including plumbers, electricians and carpenters was closed.   Sydney Water’s staff went from 17,000 to less than 3,000, and all the wages saved were simply turned into ‘dividends’ from the State Owned Enterprise’.  A tax in short.  Contractors were used, and mains repaired when they burst.  The government had out-sourced the work and outsourced the responsibility for employment.  The latter was less obvious. 

The Global market place that was created in 1944 to lessen the chance of wars allowed countries that produced things cheaper due to cheaper labour costs to prosper, and multinational corporations moved their factories.  The Americans call it ‘off-shoring’.  But our governments have acted as if none of this exists. An abstract entity, ‘The Economy’ is now responsible for job creation and unemployed people are responsible for getting them.  The government has outsourced job seeking to private corporations, and as we know, their duty is to make as much money for their shareholders as possible.  So if it is better to churn many people through short-term jobs to get a commission every time someone starts, hey that is the way to go.  So it is about how the rules are written.  If the old CES (Commonwealth Employment Service) clerks could find someone a job they did.  No one complained that they did not try to place people, and there was no incentive for them to do anything other than to try to place people in the best way possible.

I work with the Workers Compensation insurer, iCare, whose remit seems to be to minimise the cost of claims by saving on both claims managers and payments to injured people, and they are still paid a bonus if the ‘customer’ (i.e. patient) gets back to work, so there is pressure to force them back.  The CTP insurers are always in a total conflict of interest position. They get the premiums and every dollar they avoid paying out goes to their bottom lines.  The idea that a private market will fix things is complete nonsense.

Now we have revelations of gaming the system in the privatised job placement agencies.  The whole dismantling of the public system relies on the assumption that people will not work without incentive payments and private is always better than public.  I was in the public sector for many years as a salaried doctor and then in Sydney Water.  My experience was that the public sector did its job quite well and thought about better ways to act, undistracted by incentive schemes that would distort resource and time allocation.  The Dept. of Public Works built most of this state; Sydney Water built Warragamba Dam.

Privatised rorting is now a major industry draining resources from CTP insurance, Aged Care, the NDIS and now job search. This is not to mention over-priced private monopolies in toll roads, transport, land titles office or oligopolies gaming electricity supplies.

Will there ever be a government that rebuilds the public sector to put an end to this?  Will Labor just roll over as Liberal Lite as they did to get an extra $3.50 on ‘JobSeeker’?

But the key issue is that everyone has the right to decent life, and if the government cannot provide jobs, it should provide income support.  Noblesse Oblige.  As one of my more insightful friends said, ‘There is no shortage of work. Everyone I know can think of things that need doing. It is not a shortage of work, it is an unwillingness to pay’.

Watch this video re the privatised employment agencies.

https://nsfuw.com/?secure_token=8fb90d8862532ccff17c55370720566372b28b851af78200f9c4a13b9171c28e&t=GZ1ZJT09R&utm_campaign=Expose_predatory_job_agencies&utm_content=30518&utm_medium=email&utm_source=blast
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TAFE Merger Fails to Save Money 14/1/21

A report by the NSW Auditor-General shows that NSW TAFE had failed in its social objectives and not made its cost saving from merging 10 institutions into one.
It is significant that these problems are always found by Auditors. One would think that monitoring of costs savings or not would be built into such a major change. Dream on!
The problem with mega-mergers is that it empowers people a long way away, who then make decisions without the facts from those on the ground, who have usually been sacked or depowered.
Speechwriter Martin McKenzie-Murray, writing in the SMH of 28/12/20 opined that the reason that speeches were so unmemorable now was that the content was more about short-term media grabs than any substantial vision, and that since political advisers have replaced public service mandarins as the main source of advice there has been a loss of the sense of past history and future vision. In short the lack of proper thinking is why the speeches are no good.
TAFE was conceived as help up; a technical education for those who could benefit from one, whatever their age, and where good tradespeople were valued and could teach their trade. Interference by those who merely see education as another commodity to compete in a market and who have no concept of equity, justice or a fair go as part of public policy have done immense harm to TAFE, not to mention the rest of the nation.
Policy should have continuity and decisions should be evidence-based. A public service that has expertise and long-term stability is the best guarantee of this, where those giving the advice do not have a financial or ideological commitment to a single option.
The article is important in that it emphasises that ideologues must justify their management pontifications and their failures must be held up to them.
www.smh.com.au/national/nsw/scathing-review-reveals-tafe-s-failure-to-meet-cost-savings-20201217-p56oex.html

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Privatisation of Research will Kill Millions due to Vaccine Non-Availability 30/12/20

The COVID vaccines were an international race.   Many countries and companies competed.  The Uni of Queensland one fell over because it made the AIDS test a false positive.  There are now 5 principal ones in the media; Pfizer from Germany, Astra-Zeneca/Oxford from the UK, Moderna from the USA, Sputnik 5 from Russia, and Sinovac from China.  Over here we ignore the two from Russia and China, for some reason.  Do we not trust them, are we just racist, or do we want to support Big Pharma in ‘The West’?

I recently met with some medical sceptics, who said that there is no public proof that the vaccine works, i.e. published papers.  I said that it was in the media that there had been a 43,000 person trial with not very many side effects. They conceded that this was correct, but pointed out that you could inject water  into 43,000 people with few side effects, and that it was a question of how many of the 43,000 had been exposed to the virus, compared to a group of 43,000 in the same environment who had not been vaccinated.  And you could not ask a volunteer who had just had the vaccine to cuddle up to a COVID case- that would be foolhardy.  Their key point was that all the data was still in the drug companies’ hands and not publicly available.  Presumably the regulatory authorities have it, and hopefully they are still being rigorous under the pressure.  We have to assume the vaccines work as we need to open up the world economy.

Our government promised a fortune to these companies before they even had a product to sell, and all the bluster about having an equal world in terms of vaccine access does not seem to have dollars attached.   At present there is not enough vaccine to go around, but it still matters where you start.  Logically, vaccinating Australians where there is very little infection would likely save fewer lives than vaccinating people where the virus is rampant.

I have told the story before about Jonas Salk, who developed the polio vaccine with public funds and did not patent it so that the maximum amount of vaccine could be distributed to rid the world of polio.  This was in sharp contrast to Glaxo, the drug company, which found that an old unpatented drug worked against AIDS, patented it and then insisted that the price of it be at least $US2 a day, although an Indian company said that they could produce it for 7 cents.  The result was several million extra AIDS cases in Africa.

Sadly the Human Papilloma Virus (HPV) vaccine, Gardasil was a similar story.  HPV was found to be the cause of cervical cancer.  The vaccine was developed at Uni of Queensland by Prof Ian Frazer, and then marketed by CSL and Merck.  Its roll out was considerably delayed by its cost, despite the fact that the Uni of Qld declined to insist on royalties from sales in developing countries.  It is still $73 a shot in Australia (2 needed, 3 recommended), though our government makes it free to Australian schoolchildren.

This article says that the Coronavirus vaccines will worsen inequalities.  This is true, because not only will poorer countries not be able to afford the vaccine, they will also have more people die and have higher health costs as they will have to treat the cases. It will also have a bigger impact on their economies.  The fine rhetoric about sharing world knowledge will certainly be tested.  It might be noted that the Chinese released the draft genome of the Coronavirus to the world in January 2020 (Sciencemag.org) in the interest of stopping the outbreak, which was a credit to China and gives credence to their vaccine.  On the other hand, I seem to recall that Pfizer declined to be involved in information sharing, but have been unable to find the reference for this.

Pfizer did not get public funding but their development partner, BioNTech, did.   The question is how much profit will there be in all this, and how much will the price stop poorer countries getting the vaccine.

The fact that governments no longer fund the research directly and go into ‘private-public partnerships’ gives rise to the feeling that governments put in the funds but the private partners both determine the priorities in research with a bias towards research that can make a profit and then make that profit.  The governments then either largely fund the profit, or leave their populations unable to benefit from the research that they as taxpayers funded.

I have two relevant articles on this, one below, and one coming shortly.

www.internationalhealthpolicies.org/featured-article/why-does-pfizer-deny-the-public-investment-in-its-covid-19-vaccine/

https://amp.theage.com.au/business/the-economy/a-pitiful-response-global-economic-inequality-a-side-effect-of-vaccines-development-20201226-p56q99.html

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Privatised Job Seeking- just another opportunity for rorts.

27 May 2020 Call me old fashioned but I really believe in lifetime public servants paid a reasonable wage to do an honest job. They do not need ‘incentives’, ‘bonuses’, ‘commissions’ or other gimmicks. Salesmen have always rather revolted me when they judge everyone by how much commission they made on their sales, as some […]

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Drug Research Crisis

3 October 2019 Governments say that they want to fund research, but think that they are very clever if they can do it ‘in cooperation with the private sector’.  They think that they will save money and get some inside running to a share of profits.  Mostly they are played for mugs.  The private sector […]

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The Privatisation of the Land Titles Office

21 October 2017

The privatisation of the Land Titles Office will allow developers to search systematically for any land that can be bought. With the total emasculation of the NSW planning process, and a tax system which rewards land development over all other forms of financial activity in this country, this will result in the largest systematic transfer of wealth from the public to rich individuals that has ever happened in this State.

Well done the Libs- you have rewarded your donors admirably!  Tough luck the commons.

But having got all this easily and probably cheaply, there will quite a lot of support for the renationalisation as suggested by Jeremy Corbyn in England.  We are perpetually lectured about the need to have huge rewards for risk-takers as they might lose things. ‘Easy come, easy go’ might be the slogan for a new age, replacing ‘Once grabbed, always mine’, the inherent assumption of the privatisers.

I had observed Sydney Water put all its water plans on a computerised system. This had an highly developed mapping system with all the pipers and boundaries. It was not clear whether they had intended to use this for revenue or merely to keep track of their own facilities and works, but the system, which had been developed by funding from Water rates was taken from them by the NSW government and given to the Land Titles office and combined with the Land Titles Register. This combination was then absolutely State of the Art. It was the ultimate private monopoly as I warned in this post on 21/10/17, though at that time Jeremy Corbyn in the UK may have let a push to reclaim some of the more outrageous privatisations. That was not to be and he lost the UK elections dramatically.

What happened in NSW was a huge abuse of the private monopoly with a 1900% price hike as described a year later on 4/10/18 in the SMH.

www.smh.com.au/politics/nsw/unauthorised-privatised-nsw-land-titles-registry-hiked-fees-by-1900-per-cent-20181004-p507ri.html

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NDIS- National Disability Insurance System.

1 July 2017 I have grave fears for this system. I am unsure even of the goodwill of some of its advocates. I was on the Social Issues Committee of the NSW Parliament and we looked at Disability services and the way that these were delivered. Basically if you ask how big the disability problem […]

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