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09/10/2025
I presented to the NSW Law and Justice Committee into Workers Compensation on Tuesday 7 October.
The Inquiry is a result of the NSW Government’s efforts to reduce the cost of psychological injury by cutting eligibility. They could not get it through the Upper House, hence it was sent to the inquiry.
It is at https://www.youtube.com/watch?v=ocavXF-Kd0U
My swearing in is at 6.28 and evidence at 6.33 and following.
28/09/2025
There is an inquiry into some types of legislation every Parliamentary term.
It tends to be routine. There are calls for submissions, but no publicity and usually vested interests merely state their positions.
In this case insurance for people injured in Motor Vehicles is under the Law and Justice Committee rather than the health-orientated Social Issues Committee, which shows the government’s priority; keeping the premiums down rather than actually making the insurance companies treat people fairly.
Here are the Terms of Reference- submissions are accepted until 7 October 2025.
https://www.parliament.nsw.gov.au/lcdocs/inquiries/3131/Terms%20of%20Reference%20-%202025%20Review%20of%20the%20Compulsory%20Third%20Party%20insurance%20scheme.pdf
Here is my submission to the inquiry, with suggestions as to what need to be done.
‘Transparent Competition and Fair Go for NTDs Needed in CTP’
A Submission to NSW CTP Inquiry September 2025
I very much welcome this Inquiry and would be happy to appear before your Committee to elaborate on and/or to clarify any other questions that you may have. I also have patients who would be more than willing to give evidence, some of whom would have difficulty doing this is in writing, but would be able to speak to the Committee.
I am a medical practitioner (GP) with a special interest and expertise in Workers Compensation (WC) and Compulsory Third Party (CTP) insurance since 1983. I have a current practice of at least 100 patients. Many of my patients are from socioeconomically disadvantaged or NESB backgrounds with the worst jobs and the highest injury rates.
My initial qualifications were in medicine and I am a Fellow the Royal College of Surgeons of England and have a Master’s degree in Applied Science in Occupational Health from UNSW. I had considerable experience in intensive care medicine and became active in the anti-tobacco movement because I realised that prevention was better and cheaper than cure. As an Australian Democrat MLC, 1998-2007, I initiated consequential inquiries into DOCS (now Dept. of Community Services), and Mental Health.
Thus, I understand health policy at both a political and coal-face level. The key problem is that the major unstated policy of our fragmented health system is that the main objective for each participant group, Federal government, State Governments, insurers and Patients is to minimise their costs without regard to the total cost of the system. This is especially true in the Workers Comp and CTP area. There is theoretical competition in the CTP area between insurers, but it is not real competition as consumers are not able to tell which insurers give them a better deal and are left to judge by the TV ads. What happens in practice is that the insurers delay, deny and dispute claims, so that patient will go elsewhere for treatment. Claims with ongoing problems are classified as ‘minor injuries’. This means that if treatment is delayed for 6 months, the insurers are free from further liability. The tactic is therefore to accept the claim, but deny investigations, so that the diagnosis can be disputed and treatment not initiated. Since there is no penalty for denials and disputes, the worst that can happen to insurers is they are compelled to do the treatment that they should have paid for, months or even years before, given the glacial pace of the legal system. It is likely that insurers have calculated that if a high percentage of denials are successful, even if they lose a few they are still better off financially with a ‘denial’ policy.
Insurers also produce ‘Injury Management Plans’ which might be considered farcical. They are 5 pages long on thick paper (clogging up any paper-filing system that retains them). They take absolutely no notice of the NTD’s diagnosis on the Certificates of Capacity and merely state the insurer’s medical code names for what they have accepted liability for. The IMPs then state the responsibilities of all parties as they would have them understood, with the obligations of the patients to do as they are told by the insurer, the NTDs to provide certificates and ;input’ to the Management plans, which remain the prerogative of the insurers. Their obligation to pay for ‘reasonable and necessary’ treatments seems neglected. I have had patients with very serious leg injuries after falls, who also sustained back or neck injuries in the falls. The leg injuries got all the attention in the EDs at the time, but the back injuries were what stopped them working in the medium term. Yet the insurer would not acknowledge liability for these contemporaneous injuries and maintained that they must have happened at a later date, as if this would happen as they convalesced with their legs up. The injuries may miss scrutiny because EDs concentrate on the most serious immediate problem and the strong pain killers given may mask other injuries. What needs to happen is that the insurers must either accept the diagnoses on the NTDs certificates or have it disputed through a medical panel immediately. The IMPs could be thought of as a complete waste of medical time, but NTDs are paid $100 to read and accept them (easy money) and they serve to reinforce the insurers’ right to ignore diagnoses that they may have to pay to treat later and reinforce their right to have the final say on management.
Most GPs do not dispute the denials and some Rehabilitation practitioners engaged by the insurers see the insurers as the client rather than the patient, push the patient back to work when they are not yet ready and try to bully the GPs to do the same. I have had two insurer-hired Rehab companies tell patients to change their GPs when the GPs did not do where they wanted.
The system of using Independent Medical Examiners (IMEs) by insurers has to be changed. These IMEs have a strong financial interest in coming to clinical assessments that favour insurers. Medical problems are minimised or attributed to age or other factors that were completely unnoticed until the date of the accident. Their assessments very frequently result in treatment denials or withdrawal of liability for diagnoses with consequent withdrawal of benefits. The impecunious patient then appeals to a lawyer, who arranges another IME, a dispute results and the PIC has to sort it out with yet another IME. This delay is immensely detrimental to the patient’s finances, psychological state and often their long-term outlook. A better system would be to have the insurers obliged to pay the NTDs management plan or appeal to a Medical panel. The ideal would be a medical panel chosen by the relevant college without insurer input, so that it is a medical decision what is ‘reasonable and necessary’ treatment. An alternative that might save time would be an IME agreed by both insurer and the patient’s lawyer, but most patients do not have lawyers, and obviously it is better if they do not need them.
It might be noted that the legal system redress processes are so slow that in many cases the damage is often irreparable before they even have a hearing. My disadvantaged patients are often paid in cash and have less than 3 weeks before they are unable to pay for food and rent. The time taken by insurers to approve cases and Nominated Treating Doctors (NTD) requests is extremely destructive to patients. The denial of a large percentage of treatment requests is not monitored by the State Insurance Regulatory Authority (SIRA), despite my request for them to do so, and my providing evidence to them that up to 61% of treatment requests are denied. I have had a number of patients who have been strung along with treatment denials for over 5 years; my longest who actually won was 14 years.
Delays are allowed in the NSW legislation. My own statistics for CTP, which I gave to the Hayne Royal Commission on Financial Services showed that in an unacceptably large percentage of cases treatments were denied by insurers. NRMA was the worst at 61%, Allianz at 43%, QBE 36% and Suncorp (GIO and AAMI) at 19%. Another source, which I am not at liberty to disclose, had a sample size 10 larger than mine, with similar results. These figures were from 2016, but I do not believe the situation has changed significantly. It might be noted that insurers have ‘accepted’ a very high percentage of the claims, but then refuse the treatment of these claims without this being noted or sanctioned by SIRA. It seems that SIRA functions as a senior insurance clerk to minimise payouts, but not in any way as a patient advocate. Our CTP system, which started as a means of getting top rate care motor accident victims in NSW, is now examined in terms of ‘the impact of the bill on cost and economic conditions’. It is significant that it is the hands of the Law and Justice committee rather than the any health-related committee. If our current situation is viewed merely as a cost to be minimised by the insurers, employers and NSW Government, we can only expect to see ever-declining health outcomes for my patients and our NSW community. It seems that there has been an immense influence into the systems of algorithm-generated management plans and US input so that CTP and WC systems are training and preparing for the days when insurance companies decide what treatments will be done, and doctors do what they are permitted to do by insurers. I first encountered this in 1983 when discussing treatments with American doctors at a conference. While all the non-US doctors discussed the subject in terms of optimum drugs and protocols, the US doctors talked about what they were allowed to do in terms of individual patient’s insurance schemes. It is now normal there and coming here by stealth.
The best way to save costs is to optimise treatment. Generally this means empowering GPs, who are the Nominated Treating Doctors (NTDs) actually to do their jobs without insurer delays and denials. It might be noted that GPs do not make any money from investigations or referrals. There may also be an insurer prejudice against GPs, on the assumption that if an accident were serious it would go to an Emergency Department (ED). While it is true that serious accidents usually go to EDs, whiplash injuries and back pain are very common after non-fatal accidents and the problems from these may be ongoing for years, which is presumably why insurers do not want them investigated.
It would appear from an NTD medical perspective that treatments are still denied according to either an algorithm or a protocol to save money, and these algorithms or protocols are presumably based on statistics. The point about medical practice is that every case is an individual and that probability is not certainty. Every case is individual and must be assessed on its merits. Insurer decisions must be transparent, and if they are made by a computer algorithm or protocol these must be made transparent for a medical discussion, not merely a financial one.
It must be acknowledged that the current system is immensely adversarial. The insurance clerks who are responsible for cases are somewhat pretentiously called ‘case managers’, which of course should be the role of the NTD. They are rotated frequently, and it must be asked why this is. The suspicion is that they must not be allowed to become too close to the ‘clients’, i.e. patients that they are managing. They use first names in all their correspondence, but only the first initial of their surnames, presumably so that they can remain anonymous as they refuse reasonable treatments of those who absolutely need them. . One would have thought that they would be proud to have their names on their work as all health professionals are, but in practice, this is the land of ‘deny, delay and dispute’ rather than that of Help.
The medical notes are so available as to make ‘medical confidentiality’ a farce, yet insurer records are entirely opaque, protected by ‘legal privilege’. So while the NTD have to justify any decision or even a long consultation, insurers do not have the same rules applied to them. NTDs are often not even informed of treatment denials- their correspondence is with the patient. Insurers seek to replace NTD medical management with insurance clerk management. Phone inquiries from NTDs are difficult and calls are not returned more often than not. Calls are recorded supposedly for ‘training and quality purposes’, but I have had experience where the questions asked by the case manager were clearly written by lawyer as a cross examination, so I am now reluctant to answer questions or have the conversations recorded. Interestingly most insurance clerks are unable to turn off the recording. Some offer to ‘delete it later’- clearly an unacceptable alternative. Liaison between insurers and employers also seems to be poor, communication being via rehabilitation professionals late in the case management. If the doctors’ records are to be available for perusal and judgement, then the insurers’ cases records should be similarly available for subpoena. Perhaps the reasons for unconscionable delays might be elucidated.
Two non-medical aspects are worthy of the Committee’s attention:
1. The CTP system now has some degree of wage substitution, which is a good and necessary thing. However, many students and migrant workers are paid in cash for at least part of their work. When they are injured the wage substitution only encompasses the part that was taxed. Currently employers are happy to understate incomes to keep their premiums lower and insurers are happy to accept these low numbers as it lessens their payout. The victims need to have their incomes maintained and should be assessed by what they had received, though this naturally has practical problems.
2. Police should be required to make a report in all accidents that are reported to them, and note that the accident took place, who was in the wrong and some degree of the severity of the accident. I have had people with significant whiplash injury denied compensation because the insurer considered that he dent in the bumper bar was not deep enough and have had people significantly injured where the other party denied that the accident took place at all. A person made racist slurs and deliberately ran into another car (which caused immense psychological injury).
(There is also some fraud where independent assessors hugely overstate the damage done to cars and repairers do needless repairs, sometimes buying ‘courtesy cars’ which they loan to the owners and charge the insurers exorbitant hire charges to pay off the courtesy cars. Naturally this scam affects insurers rather than my patients, but attention needs to be given to accreditation of assessors. This is a motor accident matter, but not a CTP matter. Having police attend would also make this less likely).
The solutions for the Medical management of CTP are:
1. To recognise that the problem of the CTP system is that it is a dysfunctional medical insurance system which minimises short-term treatment costs, which perpetuates the medical problems while maximising the administrative, investigative, medical reassessment and legal costs. The delays adversely affect outcomes. Improving treatment should be the first step in lessening costs;
2. To put the NTDs at the centre of the system, allowing them to organise treatments as happens with all other forms of health insurance. This needs to be mandated by law or regulation or insurers will not do it.
a. NTDs should be able to order the same investigations, referrals or treatment that are reasonable and standard in private practice, and the insurers should be obliged to pay for them as any other health insurance fund does. Appeals against this by insurers should be to a panel of doctors appointed by the specialist colleges. It might be noted that published protocols for emergency department management of cases require immensely more investigations than are suggested by GP NTDs.
b. NTDs should choose the rehabilitation professionals. If insurers feel that rehab is needed, they could suggest this to the NTDs;
c. NTDs should be notified of approvals or denials of medical investigations or treatments at the same time as the patient, and be able to comment on these and appeal the decisions.
d. NTDs should be given copies of the reports of IMEs (Independent Medical Examiners) used by either insurers or defendant or plaintiff lawyers within a week of their being received by the insurer or lawyer, and be given an opportunity either to use the opinion for the patient’s benefit, or to respond to it.
3. To have a significant treating doctor input to the management of iCare and SIRA, both at an administrative and a case management level;
4. To make SIRA collect and make public figures on treatment delays and denials from all insurers;
5. To make SIRA a true regulator that acts for patients and sanctions insurers for unreasonable decisions. Sanctions for unreasonable treatment denials should be able to be initiated by plaintiff solicitors and ruled in the Personal Injuries Tribunal to lessen treatment denials; and finally
6. To make insurer case records as transparent as medical records are, so that the basis of decisions and their timeliness and origins are transparent and accountable.
7. To make insurer algorithms transparent and vetted by specialist colleges, who may be asked to prepare their own algorithms or flow diagrams for common conditions, so that what is ‘reasonable and necessary’ will be disputed less. This must be done by Medical Colleges without insurer input, as it might be noted that the whiplash guidelines were made by a SIRA committee which had insurer input but no input from emergency physicians or neurosurgeons, the two specialties that had the most interest in the outcome.
This is a complex area and I would be willing to appear and answer any question that the Committee might have on the working of the CTP scheme and possible alternative systems.
I attach two Appendices from my submission to the Hayne Royal Commission:
First, a 2- week survey of my patients to show the extent of insurer interference in reasonable and necessary treatments (Appendix 2);
Secondly, figures for radiology and specialist referral denials by insurers (Appendix 4).
Yours sincerely,
Dr Arthur Chesterfield-Evans M.B, B.S., F.R.C.S. (Eng.), M.Appl.Sci. (OHS), M.Pol.Econ.
636 New Canterbury Rd, Hurlstone Park 2193
0419 428 019 (m)
30/07/2025
22 July 2025
I very much welcome this Inquiry and would be happy to appear before your Committee to elaborate on and/or to clarify any other questions that you may have. I also have patients who would be more than willing to give evidence. I am a medical practitioner (GP) with a special interest and expertise in Workers Compensation (WC) and Compulsory Third Party (CTP) insurance since 1983. I have a current practice of at least 100 patients including a number with PTSD or stress related to workplace psychological trauma. Many of my patients are from socioeconomically disadvantaged or NESB backgrounds with the worst jobs and the highest injury rates.
My initial qualifications were in medicine and I am a Fellow the Royal College of Surgeons of England and have a Master’s degree in Applied Science in Occupational Health from UNSW. I had considerable experience in intensive care medicine and became active in the anti-tobacco movement because I realised that prevention was better and cheaper than cure. As an Australian Democrat MLC, 1998-2007, I initiated consequential inquiries into DOCS (now Dept. of Community Services), and Mental Health.
The key lesson from our successful tobacco campaign and those inquiries, and those since, is that money spent at the end-stage will not produce the most effective, efficient and equitable results. It is like having the only health services as intensive care units – no matter how much money is expended, no effective improvement will be produced, and costs will only be saved by reducing services, naturally leaving some people untreated, thus generating additional pain and suffering, as a consequence of shifting costs elsewhere. It would be tragic if this were to be the case with WC in NSW at the current time.
I am currently treating at least 6 long-term workplace psychological trauma patients where timely industrial relations (IR) interventions would have resolved the situation far more quickly, effectively and cheaply, had adequate advocacy been available. The chance of these workers’ compensation cases returning to work is
now frankly poor despite the fact that they have had the best psychological and psychiatric attention.
It might be noted that the legal system processes are so slow that in psychological cases the damage is often irreparable before they even have a hearing. My disadvantaged patients are often paid in cash and have less than 3 weeks before they are unable to pay for food and rent. In my extensive experience the time taken by insurers to approve cases and Nominated Treating Doctors (NTDs) requests is extremely destructive to patients. The denial of a large percentage of treatment requests is not monitored by the State Insurance Regulatory Authority (SIRA), despite my request for them to do so, and my providing evidence to them that up to 61% of treatment requests are denied. I have had a number of patients who have been strung along with
treatment denials for over 5 years; my longest was 14 years. (While it took 14 Years for my Workers Comp. patient to have back surgery approved, by then he was reluctant to return to work (RTW) as he feared being re-injured).
The UnitedHealthCare insurance executive who was gunned down in New York had the words, ‘Delay, Deny, Depose’ [sic] written on the cartridges from the fatal shots, a corruption of the title of the book, ‘Delay, Deny, Defend’, which critiqued the US health insurance industry. It has been reported that about 33% of the cases
were denied by his Company, one of the biggest health insurers in the USA. Delays are allowed in the NSW legislation. The percentage of denials of NTD treatment requests and the delay of approvals is not monitored, despite my requests for same. My own statistics for CTP, which I gave to the Hayne Royal Commission on Financial Services showed that in an unacceptably large percentage of cases treatments were denied by insurers. NRMA was the worst at 61%, Allianz at 43%, QBE 36% and Suncorp (GIO and AAMI) at 19%. Another source, which I am not at liberty to disclose had a sample size 10 larger than mine, with similar results. These figures were from 2016, but I do not believe the situation has changed significantly. It might be noted that
insurers have accepted a very high percentage of the claims, but then refuse the treatment of these claims without this being noted or sanctioned by the State Insurance Regulatory Authority (SIRA). It seems that SIRA functions as a senior insurance clerk to
minimise payouts, but not in any way as a patient advocate. Our Workers Comp system, which started as a means of getting top rate care for injured workers in NSW, is now examined in terms of ‘the impact of the bill on cost and economic conditions’. If our current situation is viewed merely as a cost to be minimised by the
insurers, employers and NSW Government, we can only expect to see ever-declining health outcomes for my patients and our NSW community. The best way to save costs is to optimise treatment.
You may be aware that John Nagle, the Ex-CEO of iCare was sanctioned for his use of algorithms. It would appear from an NTD medical perspective that treatments are still denied according to either an algorithm or a protocol to save money, and with no sanctions and so few disputed it is economically advantageous for insurers to deny on any pretext. The system is immensely adversarial. The medical notes are so available as to make ‘medical confidentiality’ a farce, yet insurer records are entirely opaque, protected by ‘legal privilege’. So while the NTDs have to justify any decision or even a long consultation, insurers do not have the same rule applied to them. Rehabilitation companies are chosen by insurers so that most of them see their client as the
insurer, rather than the patient. The ‘case managers’ (i.e. insurance clerks) who rotate frequently, try to use first name terms, but will not give their surnames as the callous messages that they have to deliver might put them in physical danger. NTDs are often not even informed of treatment denials- their correspondence is with the patient. Insurers seek to replace NTD medical management with insurance clerk management. Phone inquiries from NTDs are difficult and calls are not returned more often than not. Liaison between insurers and
employers also seems to be poor, communication being via rehabilitation professionals late in the case management.
Given my extensive medical knowledge and experience the solutions are:
1. To recognise that many of the Psychological workplace problems could be solved by a better IR disputes system. Perhaps doctors could directly refer for IR mediation in such cases;
2. To recognise that the problem of the WC system is that it is a dysfunctional medical insurance system which minimises short-term treatment costs, which perpetuates the medical problems while
maximising the administrative, investigative, medical reassessment and legal costs. The delays adversely affect outcomes. Improving treatment should be the first step in lessening costs;
3. To put the NTDs at the centre of the system, allowing them to organise treatments as happens with all other forms of health insurance. NTDs should also choose the rehabilitation professionals;
4. To have a significant treating doctor input to the management of iCare and SIRA, both at an administrative and a case management level;
5. To make SIRA collect and make public figures on treatment delays and denials from all insurers;
6. To make SIRA a true regulator that acts for patients and sanctions insurers for unreasonable decisions. Sanctions for unreasonable treatment denials should be able to be initiated by plaintiff solicitors and ruled in the Personal Injuries Tribunal to lessen treatment denials; and finally
7. To make insurer case records as transparent as medical records are, so that the basis of decisions and their timeliness and origins are transparent and accountable.
I attach two Appendices from my submission to the Hayne Royal Commission:
First, a 2- week survey of my patients to show the extent of insurer interference in reasonable and necessary treatments (Appendix 2);
Secondly, figures for radiology and specialist referral denials by insurers (Appendix 4).
Yours sincerely,
Dr Arthur Chesterfield-Evans M.B, B.S., F.R.C.S. (Eng.), M.Appl.Sci. (OHS), M.Pol.Econ.
22/05/2025
22 May 2025
I started it, but look what has happened now.
In 1983 I attended the 5th World Conference on Smoking and Health in Winnipeg, Canada. It was all about the health effects of smoking. There were no activist or political sessions and Stan Glantz of American for Non-Smokers Rights called an evening meeting for those interested. I gave a paper on BUGA UP, which was the only paper that had to be given again because the room was too small for the audience.
I met a very significant figure, William Weis of Seattle who had a paper on the price sensitivity of tobacco. He said that if the price of cigarettes went up 10%, total consumption would go down 4.5%, so if the rise was tax, the government would make money. He also said that young people were more price-sensitive than adults, so consumption by those under 18 would go down 12% and uptake by young people would also go down by 12%.
Thus tobacco tax was a good revenue measure and good for public health.
I came home and wrote to the health minister without effect, but I also wrote to the Anti-Cancer Council of Victoria (ACCV) and ACOSH, (Australian Council on Smoking and Health) who were in WA. They were the most active bodies on tobacco in Australia at that time.
Australian tax was low by international standards at that time, being 50%. Only the US was lower among developed countries at 36%. Denmark had the world’s highest at 85%.
The Australian tobacco growers were supported by the TISP (Tobacco Industry Support Program), which subsidised them as they could not compete on price with developing countries such as Zimbabwe. The Australian tobacco manufacturing industry, mainly British American Tobacco- AMATIL and Rothmans bought just over 50% of their tobacco from the Australian growers, who were mainly in Queensland, with about 20% in Victoria and about 3% in NSW. They did this although it was more expensive because the farmers were useful as a lobby group, and the tobacco was only about 1% of the final price anyway.
The ACCV took up the excise case and started to lobby the Federal government for the 1984 budget. At that time there were both Federal and state taxes.
The campaign against tobacco in Australia differed from those in other countries largely because of the existence of BUGA UP, which had first become active in 1979. In most countries, the health lobby had been beavering away for years with little success, as the tobacco industry simply funded political parties on the deal that they could say what they liked about tobacco, but not legislate against it till the next election, when they would offer the same deal.
The smokers were said to know the risks and were supposedly happy to take them. The Non-Smokers Rights Movements, who did not like the smoke, were the forefront of activism around the world, but the industry painted the battle as one between smokers and nonsmokers and asked for tolerance and understanding. This naturally translated into non-smokers putting up with the smoke.
Great store was placed on the medical evidence of a Japanese professor, Takeshi Hirayama, who published a paper in the BMJ in 1981 showing that wives of smoking men had a higher incidence of lung cancer than wives of non-smokers. Naturally the tobacco industry denied all this, and governments, paid to dither, did nothing except talk. The Non-Smokers Rights groups did make it a political issue and tried to use product liability cases to advance their cause.
In Australia, Geoff Coleman a still unknown activist and one of the three founders of BUGA UP reframed the debate, saying it was not a battle between smokers and non-smokers; Tobacco was a rogue industry, happy to kill people to make its profits, and buying the advertising industry and the politicians as part of this business model. The advertising industry similarly was happy to say anything that its clients wanted without regard for the consequences of the consumption changes that they achieved. Hence the BUGA UP acronym, Billboard Utilising Graffitists Against Unhealthy Promotions. Cigarette billboards were about half of all outdoor advertising at that time and by far the most prolific at points of sale, so that general stores were chiefly recognisable because they were covered in tobacco ads. The key BUGA UP concept was that anyone could paint (reface) a billboard and sign it BUGA UP, so there would be a unifying concept from a public point of view without any formal structure. BUGA UP also wanted to tap into the Australian larrikin image and to use humour to satirise the absurd imagery of the tobacco ads. There were also street protests and disruptions of tobacco promotions, which were happening in shopping centres, pubs and music venues as well as all the sports sponsorships. BUGA UP activists were arrested for graffiti vandalism or staying on premises against orders to leave, and the court cases were played for publicity, and to contrast that some people were being arrested for doing good, while the industries were getting away with doing bad.
It must be mentioned that when tobacco advertising was banned from TV, the industry had switched to sponsorship, which meant that rather than paying the Telecaster directly, they paid the sport. This had two advantages; it was cheaper in terms of the amount of time that the brand was on TV, and it also gave them a political ally if there was any attempt to ban the sponsorships. They gave money to basically anyone who would take it, supporting cultural events and ethnic clubs to build the lobby, so while BUGA UP was winning the PR battle against the industry, it was getting its allies in order. This played out in Western Australia where the government tried to ban tobacco sponsorship in 1984 and was defeated. In Victoria the health forces were more successful with the Victorian Tobacco Act or 1987 raising tobacco excise to do three things; replace the tobacco sponsorships of just about everything with health promotion messages, have some grants for organisations that would promote health and fund some medical research. All the political opposition was bought out except the Tobacco industry itself. Health promotion foundations were created in Victoria, SA and WA, but the industry managed to get other State treasuries to stop the further spread of them by saying that they created the precedent of hypothecated taxes, which would reduce Treasury control over where money was spent.
Excise taxes were later rationalised so as only to be collected Federally after a High Court case ruled that States could not collect such a tax. (Ha v NSW in 1997, Ha was a tobacco wholesaler).
The rise of vapes is another story. As World Conferences on Tobacco and Health, (Later changed to Tobacco or Health) went on, the tobacco industry used to run parallel conferences in the same cities with tame doctors are produce a book of proceedings of these with summaries that took a very anodyne view of the tobacco problem, to encourage the idea that legislation was not really needed, edited by people such as Robert Tollison. These books were then sent free to public libraries, some of them mistaking them for proceedings of the world conference as the dates were similar. The tobacco industry also wanted to medicalise the whole issue of quitting, so that addiction was a medical problem to be treated by gradually reducing nicotine doses in lozenges or patches. Their conferences were often subsidised and created a market and a rationale for practitioners in Quit Clinics.
The technology of the quitting devices kept being ‘improved’ until they were a whole new drug delivery device, ready for a new market. Some companies that were ahead of the tobacco industry in their technologies were bought by the industry, who were taking advantage of the new social media market that could reach young people without older demographics being aware of what was happening. Some of the medical folk, obsessed by the carcinogenesis of tobacco, and influenced by harm minimisation strategies from hard drugs and AIDS advocated vapes as a quit aid, which immensely helped the tobacco industry in avoiding having to prove that vaping chemicals were safe; they just had to be better than cigarettes, an easy bar to clear.
At a political level, the last Federal Health Minister to take tobacco seriously was Nicola Roxon in the Gillard government. After this there were some Liberals, perhaps helped by vaping associated party donations, who felt that vaping should be encouraged, and certainly not regulated against. So instead of working hard to get the remaining lower demographic of smokers to quit, and linking vaping to smoking as other undesirable health behaviour, there was no real action, except on tobacco excise. This continued to be raised, so that the price was far too high for the poorer demographic who continued to smoke, so there was a huge margin of profit for chop chop, tobacco leaves from the farm, or for imported smuggled cigarettes.
The social marketing of vaping products had gone on unabated and medical research was trickling in showing that as many young people started vaping and went to smoking as ever managed to use vapes to quit. There were a few cases of deaths from vaping and scientific evidence that the cilia, the tiny hairs that move to mucus up the bronchi to clean out the lungs were adversely affected, but the industry has naturally ignored these and have reversed the onus of proof politically. Now they do not have to prove it is harmless, the medical profession will again have to prove it is harmful and get this through the political process. Last time this took 50 years; from smoking being linked to lung cancer in 1950, to a ban on indoor smoking in NSW in 2000.
Now with no action except excise rises since the election of the Abbott government in 2013, Labor is trying a prohibition approach that is unlikely to succeed. The vaping industry marketing is significantly controlled by tobacco and vapes are largely distributed by organised crime. An article in the SMH stated that there were 60 tobacconists for every McDonalds (SMH 19/5/25). Many recent stories of firebombing of tobacconists emphasise the criminals’ power. The challenge to stamp out vaping by medical evidence and the marketing of such evidence is now a huge challenge that I no longer have either the expertise nor the energy to tackle. Here is an update from the SMH.
The tobacco tax is a disaster playing out on our streets and in our budget
By Shane Wright
SMH May 19, 2025
The tax and policing approach to tobacco across this country is becoming a social, economic and legal disaster.
This disaster is playing out in our streets – from more than 120 arson attacks across Melbourne that have claimed at least one life to dodgy looking tobacco shops in Newtown and small “farms” in rural areas with unusual-looking cash crops, it’s clear to anyone that the current system is failing.
Not only is criminal activity becoming the norm, hundreds of thousands of ordinary people are being dragged into breaking the law every time they light up a cheap ciggie.
America launched a war on drugs, and it failed. What’s going on in this country at present is eerily similar.
Not only have ever-more expensive cigarettes created market opportunities for organised crime, but they’ve also provided smokers with products that could be worse for their health than legal products.
That’s the human side of ever-increasing excise rates being used to tax smoking out of existence. There’s also the economic side.
Treasurer Jim Chalmers is dealing with what is now a $43 billion hole in tobacco excise since 2020 that affects the provision of services, welfare and infrastructure to the entire community.
That’s due to governments of both political persuasions overestimating just how much revenue their assault on tobacco would reap for the budget bottom line. And, as revenue has fallen, governments have spent more money on trying to make up for the cash shortfall.
The situation is so out of hand that in his pre-election budget, Chalmers pumped an extra $156.7 million over the next two years into increased efforts to police the illicit tobacco trade. That was in March.
In January last year, the government announced an extra $188.5 million over four years for Border Force to work with the states in a “co-ordinated effort to tackle all aspects of illicit tobacco”.
That extra policing was partly paid for by another increase in tobacco excise, worth 5 per cent a year for three years, that began on September 1, 2023. At the time, it was estimated it would garner an extra $3.3 billion in excise revenue.
But it’s clear that it did not. In the two years since that excise increase was announced, excise collections for 2023-24 and 2024-25 have been downgraded by $9.3 billion.
Apart from the extra resources pumped into state health departments, the country now has its own version of Eliot Ness in the form of Erin Dale, a senior Border Force official who is the nation’s “Illicit Tobacco and E-cigarette Commissioner”.
Public health advocates in this country have led the way in trying to reduce tobacco consumption. From ending television commercials to sports sponsorship and plain packaging, they’ve made huge strides in making cigarettes as unattractive as possible to potential new smokers.
Price – through tax – has been another key element to their strategy. But somewhere along the line, the key economic concept of substitution has been ignored.
In this case, the substitution is whether people switch to chemist-only vaping products or get their fix via the black economy. And guess what? Australians have done both.
Given the way smokers are more likely to be lower-income earners, every large lift in excise disproportionately affects those least able to afford it. The assumption was that these people would give up.
Instead, the economy came up with another solution – a thriving, illegal but cheap market.
Public health officials, police and politicians have to come up with another way to deal with the explosion in illicit tobacco. The starting point has to be an acknowledgment that there is a cohort of people who will continue to smoke, no matter the health impacts.
And this approach has to cut the cord between federal governments and higher excise as an easy way to repair the budget. Tobacco excise is just a sign of the problems for the budget that are coming as petrol- and diesel-powered vehicles give way to electric ones.
At the end of The Untouchables, Ness is asked what he was going to do if Prohibition came to an end.
“I think I’ll have a drink,” he replies.
We don’t want a situation where people just light up and do irreparable damage to themselves and their loved ones. But we can’t continue with a series of policies that are not working.
29/03/2025
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.
26/02/2025
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.
14/02/2025
14/02/2025
27/01/2025
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
15/12/2024
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