Doctor and activist


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Category: Personal

Finland

22 June 2022
I am currently in Finland, holidaying after the EuPRA (European Peace Research Association)
Conference in Tampere.
I had hoped that there would be more insights on the Ukraine situation, but peace research has its
topics and budgets set years ahead, so Ukraine was barely mentioned and no new insights given.
Finland generally is very pro-Ukraine, with Ukrainian flags flying alongside Finnish ones at railway
stations and even Ukrainian flag stickers on traffic poles.
The conference was mainly about ‘positive peace’ which means trying to get harmonious social
policy, with papers on minority, immigrants and disadvantaged groups, rather than ‘negative peace’
which is taken to be the absence of war. So there was surprisingly little on politics or foreign policy.
The situation of the indigenous ‘Sami’ (formerly called Lapps) was also a big topic. Researchers claim
it is very hard ever to get funding for peace research, and it has to be framed as ‘conflict resolution’.
The conference had a distinctly feminist flavour both in attendance and in tone. It was very
competently organised, principally by Masters and PhD students from the Tampere Institute of
Peace Students. Despite their acronym, TIPSY, the students were very serious and organised.
Participants were shepherded around by Norse goddesses, who seemed charmingly unaware of
their aesthetic attributes.
Finland is an affluent, modern country of 5.5 million with an ambience very like Sweden. They have
the best education system in the world, and almost all speak excellent English. Signs used to be
written in Finnish, Swedish and Russian, but there is a trend towards Finnish and English, as all
Swedes speak English, and Russian is becoming less important to the Finnish economy. Finnish is
quite a distinct and unusual language, quite different from Swedish, which was used by the elite
when Sweden occupied Finland, and is widely spoken. Finland has high taxes, a good welfare system
and a very high standard of public facilities. Incomes seem high as prices are about 50% higher than
in Australia. Petrol is about $A3.75/litre. There is a Universal Basic Income and no visible poverty.
I had not known much about Finnish history, but it had been something of a rural backwater with a
very low agricultural population, principally populated from Sweden. It was under Sweden until the
Swedish-Russian war of 1721, when it came under Russia. The Swedes took it back in 1788, and
Russia took it back in 1809, but left it relatively autonomous. Finnish nationalism was relatively late
to develop, starting in the 1850s. A Scot, Finlayson, set up textile factories in Tampere in the 1850s,
based on the model of Manchester, England. Tampere became the industrial heart of Finland. Lenin
came to Finland and stayed for some time in Tampere as it had a high population of workers. He
promised to give the Finns autonomy if the revolution succeeded. He actually met Stalin in Tampere
so the Lenin Museum there claims that there was the birthplace of the Soviet Republic.
Stalin had his own methods of funding the revolution, which included robbing banks such as the
Helsinki branch of the Russian bank. Relations between the Russians and the semi-autonomous
Finns had generally been good, though the Tsar in his last days from 1899 tried a policy of
Russification, which was not popular.
Lenin had to flee Finland from the Tsarist police, but after the revolution succeeded in 1917 the
Finnish Senate declared independence. Lenin kept his promise and supported the new republic but

he hoped for world revolution, so sent help to the Reds in Finland who initiated a civil war in 1917.
The Reds were strong in the industrial cities such as Tampere. The White nationalists were more
middle class and rural. The war was short and brutal with victory to the new White republic but
many were killed and there were considerable recriminations. Russia at that time was fully occupied
with its own internal strife, but Finland respected their power, remained neutral and benefitted
from trade with Russia, as it increasingly industrialised.
In 1939, Hitler and Stalin signed the Molotov-Ribbentrop Agreement, which pledged non-aggression
between Germany and Russia and gave the western half of Poland and Lithuania to Germany. The
eastern half of Poland and all the countries east of it were ‘given’ to Russia.
The Baltic States, Latvia and Estonia were in this agreement, and so was Finland. Safe from attack by
Russia, Hitler then started WW2 by attacking Poland, and the Russians moved to take their half (so
that Poland ceased to exist). The Baltic States quickly fell to Russia, but Finland resisted, successfully
at first, but the Russians overcame them and took some territory in an unfavourable settlement, but
left them some degree of independence. When Germany invaded Russia, they demanded passage
through Finland to attack Norway, and the Finns agreed, not having much option. The Finns then
supported the Germans to get some of their territory back from the Russians, so in the settlement
after the war in 1944, the Russians took even more territory from the Finns, including part of
Lappland in the north, so that Finland no longer reaches the Arctic Ocean and Russia meets Norway
above them.
After WW2 the Finns built a Nordic welfare state and developed their industries, Nokia being the
best known example. Farm forestry is still a major industry, particularly pine and silver birch. There
are almost no grazing animals. They concentrated on education and industrialisation and their
economy grew as fast as many of the Asian ones, but with higher wages. They took a very neutral
foreign policy stance not to offend Russia, but did join the Euro currency launch in 2002.
Geographically, Finland is quite a large country as it extends so far north. It has no mountains and
only low hills and a large number of lakes which tend to have their long axes to the south-west due
to fact that the country was covered by a huge sheet of ice in the Ice Age, which moved to the south
west. It is quite warm in summer (now) and the Finns go to their summer cottages on the lakes. In
winter it is very cold, so all the houses are triple glazed and well insulated. There are no solar panels
and they are trying to become carbon-dioxide neutral, telling you on the tickets how much carbon
dioxide is produced by your bus or train journey. 28% of the electricity used is of nuclear origin.
Travelling is reasonably easy, though the Finnish language is difficult but almost everyone speaks
reasonable English. Getting used to cars on the right side of the road is a bit of a challenge, and
walking on the footpaths also, and the latter is rendered more complicated by the fact that the
footpaths also have a section for bikes and electric scooters which takes half the footpath, but there
is no consistency on which half. Finns smoke more than Australians and seem to have a lot of junk
food restaurants, so I suspect that the prevalence of obesity will be rising, especially as electric
scooters now considerably outnumber bikes, and are available everywhere to be picked up and used
after buying a plan and putting in a code.
It is a question of getting used to things, but in the meantime I am enjoying the capital of Lappland,
Rovaniemi. It is not possible to see the Northern Lights as these are at the Winter solstice in

December- here at present the sun sets for about half an hour a day and it never gets dark. The 8am
temperature is 14 degrees. I have heard that it is cold in Australia.

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Bullshit Jobs

8 April 2022


The idea of bullshit jobs is not new. It comes from a book in 2018.

However, with employment supposedly doing well, largely because we have excluded guest workers due to Covid, it is worth looking at how many jobs are actually needed.

Everyone needs something to do and a reasonable income to live on. The status of having a job relates generally to its perceived income, though there is some ‘doing good’ status associated with jobs like nursing despite their being chronically underpaid.

But technology replacing people has not brought the expected benefits because there seems no plan to spread the benefits evenly, or look at whether what is being done has any social utility. Many jobs that need doing are not done. Many people who want to work cannot, yet much energy and money is spent doing useless things.

I waste about 80% of my time as I treat Workers Comp and CTP injuries. About 20% of my time is deciding what treatment is needed, and about 80% filling in paperwork or writing reports to try to get the treatments paid for. On the other side there are a phalanx of clerks trying not to pay and to transfer the costs elsewhere. (i.e. to Private Health Insurance, Medicare or the patient themselves). Many doctors and lawyers also strive mightily in this unproductive area. The bottom line is that while the overheads of Medicare are about 4.5%, the overheads of CTP are close to 50%,; i.e half the money goes in processing or disputing claims or in profits for the companies indulging in this nonsense. And since many patients often cannot get the treatment or suffer long delays because of their efforts, it is a really bad use of human energy.

Someone needs to look hard at what we do and where the benefits go. Assuming that ‘the market’ will fix it is about as sensible as saying that ‘God’ will fix it, and is usually espoused with the same uncritical zeal.

Here is Wikipedia summary of the book:

In Bullshit Jobs, American anthropologist David Graeber posits that the productivity benefits of automation have not led to a 15-hour workweek, as predicted by economist John Maynard Keynes in 1930, but instead to “bullshit jobs”: “a form of paid employment that is so completely pointless, unnecessary, or pernicious that even the employee cannot justify its existence even though, as part of the conditions of employment, the employee feels obliged to pretend that this is not the case.”[1] While these jobs can offer good compensation and ample free time, Graeber holds that the pointlessness of the work grates at their humanity and creates a “profound psychological violence”.[1]

The author contends that more than half of societal work is pointless, both large parts of some jobs and, as he describes, five types of entirely pointless jobs:

flunkies, who serve to make their superiors feel important, e.g., receptionists, administrative assistants, door attendants, store greeters, makers of websites whose sites neglect ease of use and speed for looks;
goons, who act to harm or deceive others on behalf of their employer, e.g., lobbyists, corporate lawyers, telemarketers, public relations specialists, community managers;
duct tapers, who temporarily fix problems that could be fixed permanently, e.g., programmers repairing bloated code, airline desk staff who calm passengers whose bags do not arrive;
box tickers, who create the appearance that something useful is being done when it is not, e.g., survey administrators, in-house magazine journalists, corporate compliance officers, quality service managers;
taskmasters, who create extra work for those who do not need it, e.g., middle management, leadership professionals.[2][1]

Graeber argues that these jobs are largely in the private sector despite the idea that market competition would root out such inefficiencies. In companies, he concludes that the rise of service sector jobs owes less to economic need than to “managerial feudalism”, in which employers need underlings in order to feel important and maintain competitive status and power.[1][2] In society, he credits the Puritan-capitalist work ethic for making the labor of capitalism into religious duty: that workers did not reap advances in productivity as a reduced workday because, as a societal norm, they believe that work determines their self-worth, even as they find that work pointless. Graeber describes this cycle as “profound psychological violence”[2] and “a scar across our collective soul”.[3] Graeber suggests that one of the challenges to confronting our feelings about bullshit jobs is a lack of a behavioral script in much the same way that people are unsure of how to feel if they are the object of unrequited love. In turn, rather than correcting this system, Graeber writes, individuals attack those whose jobs are innately fulfilling.[3]

Graeber holds that work as a source of virtue is a recent idea, that work was disdained by the aristocracy in classical times, but inverted as virtuous through then-radical philosophers like John Locke. The Puritan idea of virtue through suffering justified the toil of the working classes as noble.[2] And so, Graeber continues, bullshit jobs justify contemporary patterns of living: that the pains of dull work are suitable justification for the ability to fulfill consumer desires, and that fulfilling those desires is indeed the reward for suffering through pointless work. Accordingly, over time, the prosperity extracted from technological advances has been reinvested into industry and consumer growth for its own sake rather than the purchase of additional leisure time from work.[1] Bullshit jobs also serve political ends, in which political parties are more concerned about having jobs than whether the jobs are fulfilling. In addition, he contends, populations occupied with busy work have less time to revolt.[3]

As a potential solution, Graeber suggests universal basic income, a livable benefit paid to all, without qualification, which would let people work at their leisure.[2] The author credits a natural human work cycle of cramming and slacking as the most productive way to work, as farmers, fishers, warriors, and novelists vary in the rigor of work based on the need for productivity, not the standard working hours, which can appear arbitrary when compared to cycles of productivity. Graeber contends that time not spent pursuing pointless work could instead be spent pursuing creative activities.[1]

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Loneliness and its solutions

25 February 2022


I sometimes watch Foreign Correspondent on ABC TV and by chance on 15/2/21 I came across this excellent programme on loneliness in Japan.


The ABC correspondent there looks at loneliness in the Japanese population from older folk dying alone, to younger people simply withdrawing from society.


Some of the older ones had no family or jobs. Some of the younger ones were so pressured to succeed and felt that they had failed, so simply withdrew from society. It seems that the pressure on kids all to be CEOs is an absurd and unachievable objective.


I am not sure that the situation in Australia is as bad, but I thought about some of my patients and could think of half a dozen immediately. With some of them , I am one of the only two or three people in the world they have any contact with, their relationships are tenuous.


None of them started with mental health problems. Here are some examples:


A 60 year old man worked for a security company looking after an insurance company. He was doing surveillance for them, but it took over his life as he was contacted 24 hours a day for various crises. Case management employees having conscience over what they were doing had to be rescued from self-harm in the toilets. Enraged claimants with refused claims threatened to blow up the company offices with cans of petrol. He saw staff high-fiveing as some claimant got a derisory settlement when they deserved and needed a lot more. It went on like this for years. When he said that he could not do this anymore he was treated as badly as any of the people he had dealt with. He told me this story, and I had hoped that with his considerable management skills and experience, he could be put into a less stressful position. But he deteriorated. Everything reminds him of the corruption of the world. He is estranged from his wife and they communicate with post-it notes on the frig. He goes for a walk at 11 at night so he will not have to speak to people in the street. One son has stuck by him and visits daily, and will build him a self-contained unit in his new home.


Another patient is a 62 year old ethnic taxi driver who was so badly bashed 11 years ago by a gang stealing his takings that he lost an eye, has never worked again and never recovered mentally or physically. He was divorced; lives alone and sometimes will not even answer the phone.


One is a 42 year old foreign student who came to study theology, wanting to become a pastor. Her English is not great. She is a trifle unworldly, and thought that the world is basically kind and people look after each other. She had a casual job in a motel and her boss asked her to move a bed down the stairs between floors. She said it was too heavy and she could not, but he threatened to sack her. She did it and got an injury to two discs in her back. She was frightened to have surgery, so was in agony for a couple of years and eventually agreed. She had minimal surgery, which was not successful. The insurer decided that she was not complying with what they wanted so refused to pay her. She was effectively broke and homeless, so an old lady from her church offered her a bed and food. But she lives a long way away and up a drive that is hard for my patient to walk up. She was effectively trapped. As a foreign person she did not even have Medicare for the minimal psychological help it offers (6 visits a year). Her mental health deteriorated and she shunned all outside contact, and would not even answer the phone. She has gone home to her family- I can only hope she improves there.


One is a 39 year old from a religious and teetotal family with a high sense of ethics. He was a top salesman of a computer company and became aware that they were ripping off some customers. He drew this to management’s attention, but they declined to do anything and he was labelled a whistleblower. Management supported him by putting out an email asking that he be supported for his mental health issues. He felt that this ostracisation was the end of his career, because he had asked them to behave ethically. He was certain that no one in his tight top group will now employ him, so he withdrew and started to drink to lessen the pain. His family then rejected him because of the drinking and his sales friends are estranged also. The psychologist gives him Cognitive Behavioural Therapy exercises and I try to get him to drink less and somewhat ironically counsel him that you cannot withdraw from the world merely because the baddies generally win. He lives alone, answers the phone and is just able to do his own shopping, but is not improving much.


These are just some examples that I know. Coasting home as GP at least keeps you in contact with life. The point is that many people have broken lives, but just keep living. None of these examples have done anything wrong themselves. Is a sense of ethics a mental illness?


As everyone has to ‘look after themselves’ in a consumer-oriented society, more people will fall through the cracks, especially as the gap between rich and poor is enlarged by pork barrelling which puts resources into areas that need them less, tax breaks for the rich, subsidies for private schools and private health insurance, derisory welfare payments, and insurers allowed simply to refuse to pay without penalty.


People need basic support with universal housing and universal health case. They need jobs or at least occupations and an adequate income to survive. And we need outreach and support services that can be called upon.
When people say, ‘There are not enough jobs’, they are taking nonsense. Anyone can think of many worthwhile things that need doing. And there are plenty of people who would be happy to do them. The problem is that in a world where nothing can be done that does not make a profit, a lot of things that need doing are not done. That is where the policy change are needed. We cannot simply look at the money and see to what level existing activities can be maintained. We need to look at what needs to be done, and then work out how to achieve it. We need to decide that everyone has a right to live and those who have a good life will live in a better society if everyone can share at least a basic quality of life. There has to be recognition that the ability to be profitable need not be the overwhelming criterion for what is done. Tax may go up, but if there is real re-think of priorities, it is not likely to be all that much.


The link to the ABC program that initiated this tirade is below.
https://iview.abc.net.au/show/foreign-correspondent/series/2022/video/NC2210H002S00

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Djokovic Fiasco reflects no credit on Australia

6 January 2022

Most people know that Novak Djokovic is pushing to be the Greatest tennis player Of All Time (GOAT) and needs just one Grand Slam victory to achieve this. Most also know he has been very successful in the Australian Open, which starts next week.  There is little doubt that a lot of people, myself included would be very interested in whether he can win after his failure against Medvedev in the US Open.

Many people are aware that he has been anti-vax and he unwisely attended a tournament last May and he and a number of others got COVID19, presumably by the Delta variant, but this is not recorded.

He has never been a popular as the smooth Roger Federer, or the rougher battler Raphael Nadal who are his great rivals for the GOAT title.  He was seen as not quite as warm a character.  He was praised by the President in his native Serbia for his early victories, but this cooled a bit when he made politically progressive statements.  His anti-vaxx statements have been frankly embarrassing.

Australia has a rule that if you are not vaccinated you cannot have a visa. 

Whether this should be the only criterion for entry should be a moot point.  With most infectious disease, having antibodies at a certain level assumes that you are immune to reinfection with the same disease.  This works for polio, but with ‘flu, where the virus changes, people get infected by a different strain every year.

The CDC (US Centre for Disease Control) guidelines are somewhat equivocal about antibodies. They will not say that having antibodies means either than you cannot be infected or that any infection will be minor.  It seems that COVID is considered more like ‘flu than polio.

It was not clear on what ground Tennis Australia allowed him to come, but now Border Force have excluded him, and the Prime Minister smugly talks about rules being rules.

It is important that we are protected, and many Australians have endured a lot of suffering in lockdown to achieve this, so they have little time for people to be treated differently.  But if Djokovic had COVID 6 months ago, it is hard to believe that he constitutes a high risk when the whole country has decided to abandon masks, distancing, QR codes and venue number restrictions. One might wonder what his antibody status is, or whether this was known.

It is important that various agencies in a country remain independent. We do not want Border Force deciding medical issues, nor Tennis Australia deciding immigration policy.  But Australia looks pretty silly, when one group allows him and another does not.  As a tennis watcher, I would like to see him play, and it does seem that the politics are overcoming the science. 

Now we bring in the lawyers, another idiot factor?

www.smh.com.au/sport/tennis/novak-djokovic-launches-court-bid-to-fight-deportation-20220106-p59mdp.html

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Fake Science now an Industry

6 January 2022

Many years ago (?1977), I applied for the job as editor of the Medical Journal of Australia.  I had done two years as a surgical trainee and took a year off from the somewhat disillusioning hierarchical system.  I had done 3 and a half years of university English, but in terms of my experience editing, it was perhaps a long shot.

The salary was roughly the same as a second year resident, though more than half that salary had been overtime.  The job seemed a bit of dangerous niche, but it was worth thinking about.  I didn’t get the job (Dr Alan Blum from the US did), but was invited to apply for Deputy Editor.  The salary here was $20,000 less, which was more than a third. But the key reason I declined is that I hate having someone else waste my time. 

There is such an incentive to publish in order to climb academic ladders that most writing is done for the writer, not the reader.  As many papers are written as possible, so the idea of spending a lifetime sorting through thousands of papers to find ones of merit seemed a hazardous occupation with a great danger of drudgery.

When I thought about the issue I devised the Chesterfield-Evans theory of knowledge acquisition. It is an exponential graph with time on the horizontal axis and knowledge in the vertical.  With a little time you can get quite a lot of knowledge, but to get a little more or to get the forefront takes an immense amount of time, for the last bit of knowledge. This extra bit of knowledge may be well rewarded financially in medicine if you get it ‘approved’ as a specialty, but in many scientific endeavours there is no reward at all.  Getting to the forefront is made harder by the lack of incentive to write concise papers for the benefit of the reader.

In practices as a medical professional the explosion of information of indifferent quality has made reliance on key journals the easiest way to go, but even here the increased specialisation makes even being a reasonable generalist more difficult. The monetisation of knowledge makes the specialties not want to share all their information, the college and universities act like businesses and the drug companies want to sponsor a certain view.

When I wrote both my Masters theses, getting a good supervisor was a problem. No one really wanted to go through the writings of yet another postgrad.  My supervisor, Dr Chris Winder said that he would simply prefer students write concise papers and send the lot to a publisher, giving degrees to the ones considered worthy of publishing. 

But there has been a profusion of journals, initially driven by the profitability of these.  Now the pressure from students has been joined by a rogue element, the dodgy rip-off factories.  Plagiarism and now straight out fraud are now industries.

Those who seek knowledge now have to be more discerning. There is delight amongst the non-scientific who can, like Pontius Pilate ask, ‘What is truth’ and then also like Pilate not want to know the answer.

Sadly, politicians and managers who have agenda other than optimal knowledge are flourishing  in this environment.

I am glad that I did not become a medical editor; it is hard enough getting a broad-based knowledge of reasonably indisputable facts.

I am quite unsure how the confluence of factors favouring ignorance can be countered.  Making everyone learn some science and maths at school might be a start.

How fake science is infiltrating scientific journals

Harriet Alexander

January 5, 2022

In 2015, molecular oncologist Jennifer Byrne was surprised to discover during a scan of the academic literature that five papers had been written about a gene she had originally identified, but did not find particularly interesting.

“Looking at these papers, I thought they were really similar, they had some mistakes in them and they had some stuff that didn’t make sense at all,” she said. As she dug deeper, it dawned on her that the papers might have been produced by a third-party working for profit.

“Part of me still feels awful thinking about it because it’s such an unpleasant thing when you’ve spent years in a laboratory and taking two to 10 years to publish stuff, and making stuff up is so easy,” Professor Byrne said. “That’s what scares the life out of me.”

The more she investigated, the more clear it became that a cottage industry in academic fraud was infecting the literature. In 2017, she uncovered 48 similarly suspicious papers and brought them to the attention of the journals, resulting in several retractions, but the response from the publishing industry was varied, she said.

“A lot of journals don’t really want to know,” she said. “They don’t really want to go and rifle through hundreds of papers in their archives that are generated by paper mills.”

More recently, she and a French collaborator developed a software tool that identified 712 papers from a total of more than 11,700 which contain wrongly identified sequences that suggest they were produced in a paper mill. Her research is due to be published in Life Science Alliance.

Even if the research was published in low-impact journals, it still had the potential to derail legitimate cancer research, and anybody who tried to build on it would be wasting time and grant money, she said. She has also suggested that journals could flag errors while articles were under investigation, so people did not continue to rely on their findings during that time.

Publishers and researchers have reported an extraordinary proliferation in junk science over the last decade, which has infiltrated even the most esteemed journals. Many bear the hallmarks of having been produced in a paper mill: submitted by authors at Chinese hospitals with similar templates or structures. Paper mills operate several models, including selling data (which may be fake), supplying entire manuscripts or selling authorship slots on manuscripts that have been accepted for publication.

The Sydney Morning Herald has learned of suicides among graduate students in China when they heard that their research might be questioned by authorities. Many universities have made publication a condition of students earning their masters or doctorates, and it is an open secret that the students fudge the data. The universities reap money from the research grants they earn. The teachers get their names on the papers as contributing authors, which helps them to seek promotions.

International biotechnology consultant Glenn Begley, who has been campaigning for more meaningful links between academia and industry, said research fraud was a story of perverse incentives. He wants researchers to be banned from producing more than two or three papers per year, to ensure the focus remained on quality rather than quantity.

“The real incentive is for researchers to get their papers published and it doesn’t have to be right so long as it’s published,” Dr Begley said. He recently told the vice-chancellor of a leading Australian university of his frustration with the narrative that Australia was “punching above its weight” in terms of research outcomes. “It’s outrageous,” Mr Begley told the vice-chancellor. “It’s not true.”

“Yes,” the vice-chancellor replied. “I use that phrase with politicians all the time. They love it.”

According to one publishing industry insider, editors are operating with an element of wishful thinking. This major publishing house employee, whose contract prevented him from speaking publicly, said when his journal started receiving a torrent of applications from Chinese researchers around 2014, the staff assumed that their efforts to tap into the Chinese market had borne fruit. They later realised that many of the papers were fraudulent and acted, but he was aware of other editors who turned a blind eye.

“Obviously there’s so much money in China and the journals have their shareholders to answer to, and they are very careful not to tread on Chinese toes because of the political sensitivity,” he said. “There’s a lot more they could do to sort the good from the bad because there is good science going on in China, but it’s all getting a bad name because of what some Chinese people have worked out — that there’s a market here for a business.”

Last month, SAGE journals retracted 212 articles that had clear evidence of peer review or submission manipulation, and subjected a further 318 papers to expressions of concern notices. The Royal Society of Chemistry announced last year that 68 papers had been retracted from its journal RSC Advances because of “systematic production of falsified research”.

To indicate the upswing in cases, German clinical researchers reported last week that in their analysis of osteosarcoma papers, just five were retracted before the millennium and 95 thereafter, with 83 of them from a single, unnamed country in Asia. University of Munster Professor Stefan Bielack, who published the study in Cancer Horizons, said some open access journals charged academics US$1500 to $2000 to publish their work, so they were more interested in publishing lots of papers than their scientific validity.

“There is a systematic problem and in some countries people might have the wrong incentives,” Professor Bielack said. “I think the journals have a major role. They all need to be more rigorous.”

The problem is not confined to China, but it has accompanied a dramatic growth in research output from that country, with the number of papers more than tripling over the last decade.

In 2017, responding to a fake peer review scandal that resulted in the retraction of 107 papers from a Springer Nature journal, the Chinese government cracked down and created penalties for research fraud. Universities stopped making research output a condition of graduation or the number of articles a condition of promotion.

But those familiar with the industry say the publication culture has prevailed because universities still compete for research funding and rankings. The number of research papers produced in China has more than tripled over the last decade, with dramatic growth over the past two years. The Chinese government’s investigation of the 107 papers found only 11 per cent were produced by paper mills, with the remainder produced in universities.

Until last year, University of NSW offered its academics a $500 bonus if they were the lead author in a prestige publication and $10,000 if they were the corresponding author of a paper published in Nature or Science. The system, which was designed to reward quality over quantity, was discontinued due to financial constraints.

But others have questioned whether the quality of a paper can be measured by the journal in which it is published, and an open access movement has sprung up in opposition to the scientific publishing industry, arguing that research paid for by taxpayers should be freely available to all.

Alecia Carter, an Australian biological anthropologist at University College London, said the emphasis on getting published in a high-impact journal rewarded sensational results over integrity, positive results over negative results and novel findings over building the evidence base. Researchers might inflate effect sizes or omit conflicting evidence because it muddied the overall story they were trying to tell.

“We as scientists know all these things that are wrong with the way the system is set up, but we still play the game,” Dr Carter said. “We’re all chasing the same thing.”

Dr Carter boycotts luxury journals, publishes as much as possible in open access journals and reports negative results, though this has come at a cost to her career. She was once asked at a job interview why she would bother reporting results that were not interesting.

“I said, ‘If it’s interesting enough to do the research then we should publish the results’.”

She did not get the job.

Here is an SMH article which stimulated my post:

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COVID Up Close

2 January 2022

I have tried to stay COVID safe, but we had a house guest, a friend of my son, Mike who had been stranded overseas for a year and came back to Brisbane and then to Sydney last Tuesday.  On Thursday he had a cough, so I asked him to Rapid Antigen Test (RAT), and he was positive.  Mike and I were negative, but the separation was minimal.

I was feeling a bit of a sore throat, headache and cough like an early flu and I managed to get another RA Test kit today (Sunday) and got a positive result.  Luckily, I had my 3rd vaccination 10 days ago, which is just long enough for it to start to work, so I am hopeful it will be a mild one.

It is ironic that I have had lots of requests to go back into the hospital workforce and resisted.

I will keep you posted. 

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Submission to Senate Inquiry into Newstart 29/9/2019

Introduction

This submission addresses the Terms of Reference in order. It is written from practical experience, economic knowledge and with some research. Areas in which the author does not have expertise are not mentioned. This does not mean that they are unimportant.  Comments on policy are made in relation to the term of reference, even if they are not directly asked in that term.

  1. An Acceptable Standard of Living including housing.

Two of the Four Freedoms in the UN Declaration of Human Rights are Freedom from Want and Freedom from Fear.  It is necessary that in Australia with a relatively high national income that people have enough money for food, shelter and some money to associated with others and enjoy some quality of life.  The amount of money needed for this last depends to a considerable extent on how much society’s resources are free, such as parks and health care, how much they cost such as transport, and this to some extent depends on the extent to which monopoly products, such as roads have been privatised.

The most critical item is usually accommodation. The widespread use of negatively geared real estate as an easy route to riches for those who have surplus income has led to property being seen as an asset class that cannot lose money and almost a national Ponzi scheme where everyone buys on the assumption that prices will continue to rise. This has been self-fulfilling[i], but the national private debt has grown enormously[ii], which economists have been concentrating on public debt.  The bottom line of this is that property has risen hugely in value, and in 2016 the median Sydney house price was 14 times the median income[1], but most of this value is in mortgage debt, which our banks have borrowed from foreign banks.  So those who have cashed out their capital gains have done so at the expense of those who bought, and as a nation, Australia still carries the debt, requires large interest repayments, creates a national vulnerability to a fall in our dollar and limits Australia’s ability to invest in more productive assets or industries[2].  The national obsession with real estate has been worst in Australia than other countries, and this must surely relate to the negative-gearing tax legislation.

At a practical level, rents have risen as property prices rise and this has been worst in Sydney.  People on fixed incomes simply cannot afford shelter, and this is compounded by the almost complete cessation of the building of public housing, which has resulted in housing stock being taken by those on welfare or with age and disability, creating a subculture of welfare dependency with few role models.

It is therefore an oversimplification to see the problems as just one of income.  But to address the problem requires pro-active policies in social structures and resources as well as infrastructure and education.

Given that many landlords see their properties as an investment, they are naturally keen to maximise returns. As prices rise the rental returns fall as a percentage of capital invested, even if that capital was not invested by the landlord, but is a function of the overall market price rise.  Since house prices are rising much faster than inflation, there is therefore pressure on rents to rise faster than inflation and faster than wages.  Unsurprisingly, landlords and agents often encounter resistance from tenants when they try to get rent rises greater than inflation. It is therefore easier simply to terminate the tenancy and start again with ‘market rent’. This leads to tenants being forced to move every year or so, and always having to take the rent rises.  This has meant that rents have been an ever-increasing share of incomes particularly in Sydney. The dislocati0on associated with forced moving is an ever-present reminder of the power structures in society and a significant demoralising factor for a considerable segment of the population. 

The changes in tax so that housing investment was seen as more long-term might begin to addresses these problems, but it requires some political courage as the idea of negative gearing is embedded in the society.  Property investors are aware that they are getting rich by borrowing but less aware that the selling to get rich relies on someone else’s borrowing and cannot be sustained at a nati0onal level.

  • the labour market, unemployment and under-employment in Australia, including the structural causes of long term unemployment and long term reliance on Newstart;

Governments in Australia need to face the fact that there are not enough jobs for the Australians who need them and that the price structure is moving in a direction that is worsening the situation. There are a number of reasons for this:

  1. The use of automation to replace labour, resulting in the closure of many offices and factories
    1. The mobility of information, capital and goods that has allowed competition from  cheap labour countries to replace Australian industries with a big competitive advantage in cost structures, so that more goods are imported.
    1. The weakening of unions and the rise of labour hire companies that has allowed for increasing sub award wages, cash payments and a reduction of job security.
    1. The use of work visas for unskilled labour, creating a sub-class of workers in the agricultural, cleaning services, hospitality and semi-skilled building industry where low wages are paid and Australian residents do not even compete for jobs.

It begs credibility that the Government is unaware of what is happening as they increase the number of unskilled workers to come to Australia on temporary visas, leave the unions emasculated and the Fair Work Tribunal under-resourced for any sort of policing role.  The large number of foreign students who are in Australia as paying University fees who also need work and are a significant pool working illegally, again for cash or sub-award wages. Naturally they are in no position to complain, so act to lower real paid wages, even if they have no direct effect on statutory rewards.  Australian government must face the reality that Australia’s cost and price structures are such that employers cannot compete on price in many cases and have therefore become importers.  Structurally there will a continuing and probably worsening problem that many Australians will be unable to get jobs, and there needs to be a national strategy to create industries that are world competitive in a balance of payments sense and which will create lasting employment. Failing that Australia could take a Middle Eastern or Norwegian solution that charges far more royalties to companies exporting our resources and invests these in long term assets to support our economy. The development of renewable energy has been suggested as an export industry to develop, but it appears that the influence of the coal lobby is undermining innovati0on in this area.  Those who chronically cannot find work remain on Newstart and the demeaning effect of continually applying for jobs that do not exist must demoralise even the most resourceful person. The ghettoization of poverty as outlined above compounds this, and it is surprising that there has been so little backlash from employers getting thousands of job application that they have no possible positions for. Presumably such correspondence is easy to ignore and dispose of. 

The policy that allows ‘choice’ in schools and subsidises bus fares for children of more upwardly mobile families to attend either private schools or schools in better locations also leads to a residualisation effect where those who have less choice are all together and social disadvantage tends to be concentrated, so that there is less social help available in terms of knowledge and resources in the neighbourhood.  Shortage of capital compounds this.

All this means that there are long-term structural problems in the Australian economy, which are compounded by the inequality of opportunity in the education sector.  Currently this effects disadvantaged people more, so can be ignored by the more privileged classes if governments choose to ignore the long-term implications for the society as a whole. There are some in government who think that they are only there to get a larger slice of the pie for their own voter segment and that they do not have an overall responsibility for the progress of the nation.  This approach must not be allowed to dominate, as a refusal to recognise the above structural issues will simply compound the difficultly as addressing them in the medium term.

Clearly those that are inappropriately trained or those who try to insist on an award wage where this has been allowed to be totally eroded, will be unable to find work and will need NewStart for a long time, particularly if there are not enough jobs.

  • the changing nature of work and insecure work in Australia

The changing nature of work as noted in b. above means that many jobs are either displaced by technology or ‘offshored’ where wages are cheaper.   There are also an increasing number of ‘guest workers’ on 457 Visa who are supposedly skilled and now there are provisions for unskilled workers[3] under designated area migration agreements (DAMAs). These people are supplemented by the large overseas student body who often also need work, but are legally restricted in how much or how long they can work, making them ripe for cash jobs, sub-award wages and exploitation.  With foreign workers at least 10% of the workforce, and union membership plummeting, there is very little enforcement of pay and conditions.  It also seems that governments want to turn a blind eye to the situation. Employers in the Northern Territory readily concede that DMA mainly are in the hospitality and tourist industries, which could presumably be done by native Australians. If native Australians are only to get ‘better jobs’ then the government which is allowing all these jobs to be taken by temporary workers ought either organise such jobs or stop blaming those in Australia who do not have jobs.  It may be that if fruit pickers were paid award wages the Australian fruit could not compete in the market, but with a consumer premium on Australian product and possible action to reinforce this, it is unlikely to be the case if a real effort were made at an all of government level.

As far as the 457 visa are concerned, many of the trades coming to Australia, such as tiling, gyprocking, cement rendering, plumbing and cooking could be done by Australians, but the educational emphasis on universities and training in the medical, legal and financial areas and the deliberate neglect of TAFE, technical skills and apprenticeships has meant that Australia has a huge oversupply of wannabe CEOs and a severe shortage of tradesmen.  What training our youth have is not actually appropriate for our long term needs. The two concepts of making education a for-profit exercise and letting ‘the market’ decide as if it has intrinsic wisdom, has made many young people do inappropriate training, before ‘the market’ teaches than the error of their plans.  Governments may not be able to predict exact numbers of each occupation needed in the next 20 years, but they should at least make an effort.  The absurd mismatch of skills needed and current training practices begs serious attention.

Employers, facing competition from imports with lower wages structures have lessened their cost by making work casual and only paying for workers when they are needed. From an employee’s point of view the casualisation of work means that they do not have  stable income, which has both immediate effects and also longer term ones in that they cannot get home loans or even rental properties on that they cannot show that they will be able to meet financial commitments reliably. This further marginalises many workers and adds to social inequality.

  • the appropriateness of current arrangements for supporting those experiencing insecure employment, inconsistent employment and precarious hours in the workforce

The Author does not fully understand the overall situation with regard to current arrangements but can make some observations and recount anecdotes that relate to experiences as a professional coming into contact with support systems.  The author currently works as a doctor treating Workers Compensation and Motor Vehicle accident injuries, so observes the action of insurers who act as private support for these people and also Centrelink in terms of people getting NewStart or the Disability Support Pension.

It might be noted that the NSW government has made legislative changes to reduce the time that workers compensation and third party insurance are paid to 5 years and to give insurers more discreti0on to deny payments to injury victims. This was in order to be able to lessen premiums and be able to claim that the State was ‘business friendly’.   The premiums have fallen and the private insurers have had a windfall, but this has been at the cost of payment to injured workers, both in terms of treatment denied and in terms of income benefits obtained.  The author wrote a detailed submission to the Hayne Royal Commission re this.

The effect of this legislation has been to force people who were on compensation to seek either NewStart of the Disability Support Pension from Centrelink.  I might be noted that the Workers Compensation legislation of 2012 gave long-term compensation patients another 5 years of support, but this came to an end in December 2017.  Most of these patients had been on compensation for more than 5 years, despite the funded rehabilitation and job training programmes.  It might be stated that his gave them a better chance of finding a job than others in the same physical condition who had not been injured at work.  Nevertheless Centrelink has resisted putting many of these people on the Disability Support Pension and insists on NewStart for many people.  A discontinued survey be SIRA (State Insurance Regulatory Agency of NSW) found that only 29-30% were on some sort of benefit.  8% had been declined by Centrelink, 12% were still being assessed by Centrelink, 18% had too many assets to get a benefit (and leaves 32% not mentioned)[4].  Prime Minister Morrison boasted that fewer people were being put on Disability Support Pensions, but this actually started under the Gillard Government. The author has a patient, a migrant illiterate in English, and probably his own language who was 61 years old, had been on Workers Compensation for a back injury, had Parkinson’s disease and was a carer for his sick wife and was refused a DSP. His chance of getting a job was negligible.  When the doctor took some time to write a detailed report to help the man, Centrelink stated that they would not pay more than $150 for the report, which took a couple of hours to do as his medical history was very complicated.  He was forced onto NewStart and given a provider and lot of literature on ‘mutual obligations’ that he was not even able to read.  Attempts to call Centrelink result in waiting times on the phone of up two hours. A computer eventually answers the call and cuts the person off if they cannot give the number and its suffix (which it may not have) in a very short time.  If complaints on the website are not filled in in a certain time, the site simply switches off, losing the draft complaint.  The systemic arrogance and indifference shown by Centrelink to its clients has to be experienced to be believed. 

The author recommends that all the Committee assessing this issue try to contact Centrelink by phone, attend an office and personally interview a few people in the situation. 

  • the current approach to setting income support payments in Australia

It would appear that the level of benefits is set historically and rises only when political pressure is applied to the system.  There does not appear to be any logical formula setting the level of benefits in relation to costs, inflation, rents or the poverty line.  If this is indeed so, it is no basis to run the welfare system of a country with systemic unemployment and the need for some degree of equity to maintain social harmony. If Australia has boom times it is fair that the success be shared, if there are bad times, it is fair that the pain also be shared and the effects of downturns not borne disproportionally by the most disadvantaged.

  • the impact of the current approach to setting income support payments on older unemployed workers, families, single parents, people with disability, jobseekers, students, First Nations peoples, people from culturally and linguistically diverse backgrounds, people living in regional and remote areas, and any others affected by the process;

The author does not have quantitative data on the impact of different groups, but has anecdotal evidence of patients utterly depressed about how they were treated by Centrelink, in despair about their ability to pay their bills and expressing a lack of hope for the future and suicidal ideation.  Older workers feel that they have no hope of ever getting a job.  Young unemployed complain that they cannot have a life as they have no money to get to job interviews, cannot join their friends for a drink or any social activity such as a coffee or a movie. This is very destructive of their self-esteem.

  • the impact of geography, age and other characteristics on the number of people receiving payments, long term unemployment and poverty;

The author works in suburban Sydney where the effects are very significant as stated above.  Unemployed people have difficultly even getting to a doctor in suburban Sydney due to lack of funds and are frequently changing address as they have to couch-surf as they cannot afford rents.

  • the adequacy of income support payments in Australia and whether they allow people to maintain an acceptable standard of living in line with community expectations and fulfil job search activities (where relevant) and secure employment and training

The oncome support level is quite inadequate for any sort of quality of life, and there is insufficient money even to carry out job search activities.  Young people need computers, printers and stationery to write and send resumes to meet their ‘mutual obligation’ targets, and it is even difficult to get haircuts, reasonable clothes and transport to the interviews if any. The costs of mobile phones are also a significant expense.  If they do not have unlimited time on their mobile phone contracts they are likely to run out of credit before Centrelink even answers the phone. If they do not have unlimited time they cannot afford to call Centrelink.

  1. the economic cost of long-term unemployment, underemployment, poverty, inequality and inadequate income support payments;

It is difficult to quantify the long-term costs of unemployment. The loss of self-esteem and the behavioural changes that this may create may be very destructive but are also an opportunity cost; what may have been is lost.  The loss of experience means defects in a CV and those who have a current job are usually preferred over those who do not, creating a spiral of long-term unemployment as the longer the unemployment, the more likely it is to be prolonged. Eventually the long term unemployed form a subculture of demoralised and invisible people.  It is somewhat surprising that there has not been more street crime with muggings such as happens in the US, when the unemployed lose all faith that society will look after them, see the average person’s indifference and therefore target random employed people. What society decrees as ‘survival of the fittest ‘in the normal economic and social framework may become a far more basic ‘survival of the fittest’ in a back alley, as happens in the USA.

  • the economic benefits – including job creation, locally and nationally – of increasing and improving income support payments and supports, and decreasing poverty and inequality

It is likely that the fiscal stimulus of an increase in NewStart payments and the DSP are likely to be very beneficial . It must be noted that the governor of the Reserve Bank, Philip Lowe has called on the Federal government to provide fiscal stimulus[5] as the tax cuts and low interest rates have not been enough to increase consumer spending, which is the major engine of economic growth.  It is know that poor people spend a much greater percentage of their income, in that they are not able to save.  Hence money given as an increase in NewStart or the DSP is likely to have a better economic multiplier to the economy than either tax cuts or infrastructure spending as the tax cuts tends to go proportionally to higher income who have an increased propensity to save, and infrastructure spending also has corporate profits retained.  The RBA has noted that long term increases in income lead to a greater propensity to spend than one-off payments[6], an unsurprising conclusion.  It has been stated that poorer people spend close to 100% of extra income, and this is certainly likely to NewStart recipients, whereas wealthier people may save up to 30%, having a far lesser multiplier effect in stimulating the economy.

The social effect of raising the income of welfare recipients are likely to be a reversal of the problems detailed above in proportion to the magnitude of the increase.  It will reduce inequality, give some hope to those on welfare and as such it is very important to the social cohesion in Australia.

  • the relationship between income support payment levels, minimum wages and wage stagnation in Australia and other comparable economies

The level of income support needs to approach wage levels to achieve the ability of welfare recipients to have a reasonable life.  Some people assume that if the unemployment benefit level approaches that of a low wage that unemployed people will not strive to get work.  This assumes that work is only an economic activity.  It is far more than this; it is a route to social acceptance and feeling of participation. Those who take this highly economic view of work are usually very dry and have not spoken to those who are unemployed and would benefit from doing so.  There is only danger if the loss of transport and health concessions by virtue of being unemployed are lost as soon as work is started and then have a long lead time to be reinstated.  One of the more callous ‘reforms’ of the Morrison government was to only pay benefits when they were granted, rather than backdated to when the application was first made.  This has doubtlessly saved the government money, but people do not apply for benefit until they can demonstrate a need for them and they are able to demonstrate such need at the time that they apply.  Clearly they have difficulty surviving while their claim is processed and there should not be an incentive for Centrelink to delay processing application, which is currently the situation. 

It is unlikely that the level of welfare affects the level of wages. What is more important is that those who only have welfare are able to have a decent life.  There are too many policy makers who mix up their private moral prejudices with evidence-based policy. This leads to assumptions that those without jobs do not want them and they must be punished for not having a job.  A more cynical view is that blaming the victims encourages people not to look at the inadequacy of the elite who unable to govern for the whole of society, unable to provide enough jobs for those who need them, or even to have an honest examination of the problems in society that cause these problems.  As one humane person commented, ‘There is not a shortage of jobs.  Anyone could give you a laundry list of things that need to be done.  There is lack of structure that will pay the people who do not have jobs to do things that need to be done’.  A job as currently defined is a task that either makes a profit for the employer or the government is willing to subsidise with taxpayers funds.  With government shrinking, and international and technological competition restricting industry, and government following an ideology that it must become smaller, most industries are shedding labour, even when it would be better to have it, for both the workers and the society.

  • the interactions with other payments and services, including the loss of any increased payments through higher rents and costs

The cost of providing people with a basic income should not be surrounded by a paranoia that other costs may rise.  It is certainly possible that a rent subsidy as an isolated measure may raise rents if it increases the resources of the renters without changing the quantity of rental stock.  Presumably the only thing that would keep rents down is vacancy and people unable to pay the asking rent. So if the amount people can pay rises these properties will rise in rent. But to simply subsidise rent without a policy to provide affordable housing will inevitably have this effect. The problem is not the rent subsidy; it is the lack of provision of affordable housing.

  • the cost and fiscal sustainability of any changes

The cost of increasing Newstart can be calculated. The fact that this is of comparable magnitude and is almost discussed as an option illustrates how little care the government has for the welfare of people that they are unable to provide jobs for.  The price is the price of having a fair society.  If this requires a bit more tax this should be raised.  The permanent cutting of taxes when there is a temporary boom in commodity prices is extremely irresponsible policy, and it may have to be reversed. The achievement of a surplus at the expanse of giving poorer people the means to live says a lot about the priorities of government, the commodification of people, and how out of touch our leaders are with quite a large segment of society.  If they wish to take a moral stand, one might remind them that a society should be judged by how it treats its weakest members. Pious people shod remember the story of the Good Samaritan and the questions asked, ‘Who was this man’s neighbour?’

  • the relative merits of alternative investments in health, education, housing and other programs to improve outcomes;

One of the key needs is affordable housing. Without housing it is very difficult to organise a life. Currently unemployed people in Sydney have great difficulty finding accommodation and rely on friends or relatives, sharing rooms, couch surfing and moving relatively frequently.  Money put into affordable housing would be money well spent, and is frankly a disgrace that housing has become an asset class for investors who build for the aspiring middle class rather than affordable housing and the government seems content merely to watch as inappropriate housing is built for much of the need. Indeed government housing is now largely confined to more and more disadvantaged groups, creating ghettos of social problems.  The provision of affordable social housing should be a major priority as shelter is a major human right.

The provision of access to health is also a human right.  The word ‘health’ has been appropriated and now in common political parlance refers to ‘access to insurance to pay for treatment of sickness.’  Health is actually the absence of sickness and it is far cheaper and better to maintain it than to merely pay for treatment of those already sick. Access to good food and housing are far more cost-effective than medical programmes, particularly private health insurance, which has an increasingly elective nature in terms of what is done, and the degree of luxury in which it is done.  A retiring US Surgeon-General was asked ‘what was the greatest medical advance in your time?’ and to the surprise of the questioner replied, ‘The introduction of Food Stamps’.  He recognised the importance of nutrition in the maintenance of health. In the US, with its niggardly attitude to welfare there are increasing problems with nutrition for r poor people and controversy over the payment for this such that there is a discussion of the need for better nutrition[7].  Australia with its poor levels of NewStart and its controversy over the cashless welfare card probably has a similar problem which is as yet not recognised.  It might be noted that there was free milk at schools in former times in Australia, and more recently there is a ‘National School Lunch Program’ in the US for children in lower socioeconomic areas[8] as they recognised that students were undernourished and this was affecting their education.  In terms of alternatives to raising NewStart, Australia may want to consider such programmes as it may increase equality of opportunity and school attendance in disadvantaged communities.  New Zealand makes use a school nurses with a wide range of functions[9]. This may a better way of delivering welfare to areas of disadvantage, especially if parents are dysfunctional.

In terms of preventive health, as opposed to treatment programmes such as school-based dental care, vaccination, or learn to swim classes may help improve health and save lives in disadvantaged communities and improve equality of opportunity. 

In terms of the cost-effectiveness of education spending, two features stand out. The first is that Australia is falling down the league tables of world school education at a serious rate and a serious level[10].  The second is that the Gonski Model of education funding has not occurred and there continues to be very high levels of subsidy to the private sector, with corresponding neglect of public school education[11].  Education is like health in that it is more important that those at the bottom get a reasonable basic standard than that those at the top get everything that can be offered.  Yet the political imperatives work the other way. ‘Choice’ in education has a  very detrimental effect in that subsidies, such as free travel and private school subsidies allow more privileged children to move to be with similar privileged children. There is then residualisation.  All those with disadvantage are congregated together with lesser resources and a lack of role models.  Clearly the poor results achieved in this situation drag Australia’s average down, as well as condemning children from disadvantaged areas to perpetuate their parents’ disadvantaged situation. Funding equality of opportunity would give these children a better start in terms of education, hopes, and employment, and as such would be an investment in reducing longer term unemployment.

It might be noted that universal health insurance is also very important.  Medicare is being undermined in that the Medicare rebate to doctors, which was set at 85% of the AMA fee in order to get doctor support for the concept, has been totally undermined. The government has not raised the rebate with inflation for over 30 years, so that the real value of the Medicare rebate has declined form 85% of the AMA rate to 46%. This s an almost 50% cut from a doctor’s point of view and is a demonstration of very bad faith by successive governments. Treatment of Medicare patients has thus returned to the status of ‘charity’ in the minds of many doctors.  Almost all specialists and many GPs will not take Medicare without a co-payment, so the ‘bulk-billing’ rates as trumpeted by the government are based on the GP habits, where quicker and more consultations have been used to make up the income deficit. But these bulk-billing figures also neglect to mention the fact that a co-payment exists for many services in addition to the Medicare bulk-bill.  Many patients go to the Emergency Departments (EDs), rather than a GP because these are free. This tends to be discouraged by the EDs so patient present later and sicker. ED visits are far more expensive than GPs, so it is false economy to save money on GPs and to push patients to EDs. It is also a cost transfer from Federal to State payments system and the overall cost to Government is greater.

  • other countries’ approaches to setting income support payments, minimum wages and awards

The level of payments depends to a considerable extent on the supply of shared or public resources. If there was universal access to affordable housing, free education, free health care and cheap public transport, income support needed would be less. Similarly if there is poor public transport, car dependency, privatised toll roads, education and health with many co-payments for doctors’ visits, school excursions and sports, more money is needed in welfare payments if there is to be any hope of equality of opportunity for children and a reasonable life for welfare-dependent adults.  Yet usually these aspects of social policy are seen in isolation.  Though the private sector is assumed to be highly efficient, the countries with the highest standard of living such as Denmark and Sweden often have very large public sectors. The point is that natural monopolies can deliver goods more cheaply than private organisations as they do not have to factor profits into their operations, so if both private and public systems were run with the same efficiency, the public one would be cheaper because of the lack of need to generate a profit.  The need for public good also needs to be calculated.  A public transport system that loses money might have huge benefits that could be costed, such as the savings o roads and parking, better air quality and making central city jobs available to people from the outer suburbs. Parents in inner city locations are familiar with problems such as difficultly staffing their child care centres as the lowly-paid staff cannot afford transport costs from the outer suburbs and either seek jobs closer to home, or do not work.  Making each element in society pay its own way without looking at an overall picture of spending and benefits amounts to having policy options confined by a very simplistic accounting system.

  • other bodies that set payments, minimum wages and awards in Australia

The setting of award wages in Australia has been traditionally done in the Courts which has in theory prevented political interference, but the destruction of unions by both changes in the concentration of workers and by deliberate political action has allowed the forces of both a global market and a large ununionised and unsupervised pool of temporary visa workers and students needing income has allowed the eroding of wages, particularly in the lower socioeconomic groups.  This has allowed the growth of an increasing ‘cash economy’.  This has created a US-style ‘working poor and underemployment, who may not be actually unemployed, but have the same problems as if they were, at times exacerbated by the lack of benefits such as a Health Care card or transport concessions that may be available to those officially on welfare.  In the mid-1980s the Australian Bureau of Statistics defined ‘unemployment’ as having less than 25 hours per week of work.  The US definition was that anyone with regular work, even an hour a week was ‘employed’.  Commentators such as Maximilian Walsh even compared the US rate to Australia’s, concluding that Australia was doing very poorly!  Political pressure soon made Australia adopt the ‘international definition’ and our unemployment rate plummeted. The calculation of index had been consistent, but the number has been relatively meaningless ever since. 

  • the role of independent and expert decision–making in setting payments

The principle that wage setting must be kept separate from government should be extended to unemployment relief.  The politicisation of welfare, the moral judgements that go with it and the relative political powerlessness of those on welfare means that a neutral and evidence-based approach to welfare needs to be established.  This may appear a radical proposition given the relatively large cost of welfare. But the danger of political interference has been recognised in having the Reserve Bank as an independent entity, and this principle is endorsed by all leading economies.   The Boilermaker’s principle in law upheld the need for an independent wage arbiter. There are also pricing tribunals that set electricity prices.  While it is true that a higher welfare payout may cause government inconvenience in that thy will have to budget for this, the current practice to grant tax cuts which are electorally popular, favour wealthy people and are granted when the economy is enjoying high commodity prices for exports also makes for budget pressures later[12].  It is an irony that governments concerned about the effect of welfare expenditures are the same ones that grant tax cuts, and are keen on privatisation deliberately undermining long term government revenue.  An independently-determined, reasonable level of welfare would create a cost obligation that would have to be managed by future governments, but this might make them less cavalier about giving away their revenue sources and make them recognise that they must manage the country for all Australians, not merely the demographic that voted for them.

www.news.com.au/finance/economy/australian-economy/viral-graph-shows-house-price-danger/news-story/8ef84bdc2aaa5bb589aa77da5522d45b

Murphy, Jason, ‘Viral Graph shows House Price Danger’ 16 November 2018 www.news.com.au/finance/economy/australian-economy/viral-graph-shows-house-price-danger/news-story/8ef84bdc2aaa5bb5


[1] www.buildsydney.com/australian-housing-bubble/

[2] Walters, Stephen ‘The Risks in Rising Australian Household Debt’ 1 August 2018 http://aicd.companydirectors.com.au/membership/company-director-magazine/2018-back-editions/august/economist

[3] www.abc.net.au/news/2018-12-10/immigration-australia-skill-english-salary-concessions-regions/10355054

[4] NSW Parliamentary Estimate Portfolio Committee 6 Transcript of hearing 12/9/19 p 35  www.parliament.nsw.gov.au/lcdocs/transcripts/2240/Transcript – 12 September 19 – UNCORRECTED – PC 6 – Customer Service – Dominello.pdf

[5] www.afr.com/policy/economy/can-t-rely-on-monetary-policy-alone-20190702-p5239x

[6] www.rba.gov.au/publications/rdp/2009/pdf/rdp2009-07.pdf

[7] www.huffpost.com/entry/food-stamp-myths_b_1334924

[8] www.fns.usda.gov/nslp

[9] /www.nzschoolnurses.org.nz

[10] www.smh.com.au/education/un-agency-ranks-australia-39-out-of-41-countries-for-quality-education-20170615-gwrt9u.html

[11] https://insidestory.org.au/what-gonski-really-meant-and-how-thats-been-forgotten-almost-everywhere/

[12] Seccombe Mike, ‘How John Howard’s Tax Cuts undid his protégé, Tony Abbott’ The Saturday Paper 20/12/14


[i]Pash, Chris ‘Here’s a look at the widening gap between wages and house prices’ 6 March 2018  www.businessinsider.com Image result for Sydney Rents v median income graph.au/chart-australian-wages-house-prices-2018-3

https://edge.alluremedia.com.au/uploads/businessinsider/2018/03/grattan-house-prices-Vs-wages.jpg

[ii] www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp0809/09rp30#_Toc228933532

Kryger, Tony ‘Australia s foreign debt data and trends’ Research Paper no. 30 2008–09, 7 May 2009

Note that this graph only goes to 2011

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Mental Illness and Stupidity 3/6/20

Quite early in my Parliamentary career I was approached and discovered 4 problems with mental health in NSW. A fellow medical student, now psychiatrist approached me and said that the system was far worse than formerly.

I had worked as an after hours call doctor in 1977 and 1983 and found that mental hospitals did not want patients sent to them, and would try to talk referring doctors out of sending them. At first they would say it was not in their catchment area, then that the patients were not really mentally ill and I did not actually know what I was talking about. Eventually I tired of this game, so I would call and tell them a brief history, my diagnosis and that the ambulance with or without police escort was on its way.

So when my psychiatrist friend said it was a lot worse I was surprised. She explained that Nick Greiner closed all the long-stay mental hospitals for a supposedly community-based service with supported accommodation, but the alternative was never funded, and the system had staggered on ever since.

Then I was in an inquiry into the rise in the NSW prison population and a government prison psychiatrist had found large numbers of mentally ill and developmentally delayed people falling foul of the law. He explained that if they became dysfunctional they could not pay for the electricity and rent so became homeless. They had no chance of getting through the complexities of Centrelink and getting money, so eventually they were caught shoplifting in order to eat and ended up in the Magistrate’s court, where, if he did not divert them, they went off to gaol. He had a pilot scheme in Sydney and ?Port Macquarie to divert them to supported accommodation at hugely reduced cost.

I went for a long weekend near Port Macquarie and met an older lady on the beach, who, hearing I was a politician said that this made me a cad and a bounder who was of no use in the major social problem which was mental health. Accustomed to this assumption about politicians, I remonstrated mildly, and she told me her story of her schizophrenic son, who had gone in and out of supported accommodation and prison for 30 years without getting much help.

Finally I want to a conference on homelessness where I met a community mental health nurse who described how after long weekends she would go to the parks and under the bridges to look for her homeless patients, to see if they were alive to take their medication. I asked that she write a summary in point form of the problems of NSW mental health. She did so, and her excellent report formed the terms of reference of the NSW Mental Health inquiry which I initiated. I asked Brian Pezutti to chair it. He was a Liberal, and had the credibility of having been an Assistant Health Minister. He was also a very thorough and meticulous anaesthetist, retiring at the next election, and keen to do something useful before he went.

The Labor government agreed to the Inquiry because I had the numbers in the upper house. The Inquiry came out in 2002 (NSW Health System Worst in Aust SMH 10/12/2002).

It resulted in a number of things. The budget the following year in NSW rose by $320 million, but mental health money was also quarantined so that it could not be siphoned off to fund Emergency Depts or ICUs further down the budget allocation tree. Most significantly it triggered a Democrat-initiated Federal Mental Health inquiry which put psychologists on Medicare and hugely increased the mental health workforce.

Needless to say, diversionary schemes were part of the recommendations, as without support, mentally ill and developmentally delayed people cannot do the functions that are needed to manage a life in society. There appeared to be some progress and the complaints from mental health workers for some time changed from, ‘we cannot afford staff’ to ‘we cannot fill our positions’.

As the time has passed, it seems that the situation has slipped back. The history of these inquiries is that there is a fuss, things improve for a while, then go back until another inquiry finds the same problems.

So I was discouraged to read that a program to divert mentally ill people from Gaol is to be axed, because some bean counter thinks it is too expensive. According to the Dept of Corrective Services it cost $181.85 per day to keep a prisoner in NSW gaols, which is $1,273 a week, or $66,375 a year. It is dubious that a support scheme could not be organised for less than this, but the idea that the only thing that matters is whether it saves money seems an appalling way to run society. Surely we should figure out what we want to do, workshop how to do it efficiently, and then work out how to fund it.

If a diversion plan is to be axed, let the NSW government tell us that there are good diversion schemes already working and prove it by having an independent body affirm that there is not an excess of mentally ill or developmentally delayed people in prisons. If such schemes existed, why was there this new one set up? There is a long history of ‘pilot schemes’ being set up to deal with a political problem, and then quietly dying when the political heat goes off.

www.smh.com.au/national/program-diverting-intellectually-impaired-people-from-nsw-prisons-faces-axe-20200527-p54wve.html

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Submission to Senate Inquiry into Adequacy of Newstart, 30 May 2019

Author’s CV I am a medical doctor and retired NSW MLC with some practical experience of the welfare systems and some knowledge of economics. Currently I am working with injured people who receive (or do not receive) Workers Compensation or CTP insurance benefits and who transfer to or are rejected by Centrelink for the DSP […]

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How the US does Spying

29 March 2020

Some years ago, I had lunch with an acquaintance of mine who was a reasonably successful manager, with a slightly less successful relationship history with men.  She was keen that I meet her latest beau, so we had a small group lunch.

The man in question was a fit-looking American in his early 50s who was keen to talk about himself, so we let him.  He was an ex-US Navy Seal. He would not quite admit that he was down on his luck, but he had a lot of training that the US needed to use, but they would not hire him in the Navy, though he could get ‘contract work’.  He would not be quite specific about this, and he assured us that if the missions went well, no one noticed anything.  That was the ideal outcome.  His life was at risk and he was well paid for each mission, but there was no ongoing commitment or pension if he was injured or had other misadventure.   As the dinner went on he said that he had recently been on a mission in Asia where he had done something and been caught at it.  He was chased by an angry mob up to the first storey of a building.  He was trapped and jumped out a window onto the canvas roof of a fruit truck. He had gone straight through the roof of the truck and landed amongst the fruit, spraining his ankle, but nothing further.  He was very lucky because just as he landed the truck drove away from the angry crowd while he lay low in the fruit.  When he got to the destination not far away, a number of people lined up and formed a human chain to unload the truck and he, being disguised and made up joined the line passing the fruit boxes and got a few coins for his efforts when the unloading finished, before slipping away into the crowd.  All very James Bond stuff.

Asked how he knew who the goodies and baddies were in all this and he said that this was defined in his brief.  In short, he was an agent acting for the US government but they were in a position to disown him if he got into trouble.  He was a pleasant enough fellow, and more interesting than many dinner companions, but I have not seen him again.

So I was interested to read the article below about how ‘an ex-FBI agent had died in Iranian custody’, having ‘disappeared in murky circumstances in March 2007’, ‘during an unauthorised trip for the CIA to gather intelligence on Iran’s nuclear program’.  Iran had ‘kidnapped a foreign citizen and denied him any basic human rights’.   He was ‘a gentleman’ and ‘outstanding’ said President Trump.  Perhaps.  And I like to think of myself as a champion of human rights.  But people do not go on spying missions for personal curiosity and this is a deadly game, ruthlessly played.  The story in the SMH is sourced from Reuters and the Washington Post but does not quite make this clear.

www.smh.com.au/world/north-america/former-fbi-agent-s-family-believes-he-died-in-iran-custody-20200326-p54e4o.html

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