Doctor and activist


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Author: Arthur Chesterfield-Evans

EV Batteries are the Answer to Australia’s Electricity Storage Problem

23 May 2024

Everyday we hear about Australia’s energy problem.  The government wants to be re-elected because it gave the electricity companies $300 for each of us to offset our power bills.

 

Less than a fortnight ago, the Government announced a new gas strategy. Gas had to be a ‘transition fuel’ because we could not transition to renewables fast enough. Fracking with its associated damage to the rock strata, environment and greenhouse gas targets notwithstanding Last week the Liberals announced a nuclear future. This week Erarang coal fired power station closure has to be delayed. And, hey rooftop solar is too much in the day time, so owners will have to pay to have the power taken off their hands as grid prices go negative.

 

Meanwhile it costs $50,000 to buy an EV in Australia, despite the fact that China has an EV overproduction problem and BYD can produce a model called a Seagull for $US10,000 (about  $A15,000). An EV has a battery that stores about 50 kilowatt hours, whereas the average home battery is less than 10kWh.  The spot price of electricity varies and it would be easy to charge the EVs on solar in the daytime and use their batteries to power the houses in the evenings. Why does this not happen?  It does require standard plugs and meters that would allow electricity to move from the car to the grid.  Electricity already goes from the grid to the cars- it just has to be able to be reversed.

 

Why has this not happened?  The small number of electricity suppliers, who are arguably gaming the system by withholding supply at critical times to raise prices, do not want supply diversified. They are building solar as fast as they can and wanting to control the solar input. They even offer to put solar on your roof as long as they can control when it is used. If individual households could store solar in their EVs, and either use it or sell it into the grid at peak times, this would directly cut into their oligopoly profits.  Why does the government not have the courage to take them on?  Probably because solar owners and people who want to profit from the EV batteries in their cars have not made enough noise to make it a political issue.

 

So lets shout:

‘We want cheap EVs and we want to be able to use their batteries to store power for Australia, lessen greenhouse gases and make some money at the same tim.

When do we want it- NOW!’

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Building Regulator Toughens Up- Joke?

House collapses, the builder is charged with 9 offences and flees. When he turns up, is tried and convicted he is fined a total of $5,450. He calls it minor and continues working for a friend.  None of the convictions were for the collapse.

May 23 2024

A house collapses, the builder is charged with 9 offences and flees.  When he turns up, he is tried and convicted and fined a total of $5,450. He calls it minor and continues working for a friend. None of the convictions were for the house collapse.

Is this some sort of joke?  No.  It is another example of our legal system in action- in this case the ‘beefed up’ NSW Building Regulator. Building Minister Anoulack Chanthivong says the charges reflected the new powers of the Building Commission.

See SMH article below:

On the run for months, builder of collapsed home convicted of fraud

By Anthony Segaert and Olivia Ireland

May 23, 2024

The man whose company built a Condell Park home that collapsed in the dead of night last year has been found guilty of a string of fraud-related charges.

Thirty-five-year-old George Khouzame, director of Hemisphere Constructions, was on the run from authorities for nearly two months at the beginning of the year, before he handed himself in to NSW Police in March.

Khouzame, from South Hurstville, pleaded guilty to nine offences relating to using an unlicensed contractor and the fraudulent lodging of insurance applications on three different worksites, but Building Commission NSW and the state’s police failed to secure any prosecutions relating to the Condell Park home collapse.

When asked about the charges, Khouzame told the Herald that, after having his building licence cancelled shortly after the collapse, he had paid out “every single home owner” who had contracted him for work and his fraudulent insurance claims were “just negligence from my office”.

“It was a very, very, very, very low-end fraud. It was literally an honest mistake from my staff in the office,” he said of the nine convictions: three charges of publishing misleading material to obtain financial advantage, two charges of dishonestly obtaining financial advantage by deception, three charges of making false or misleading statements in an insurance application, and one charge of engaging an unlicensed contractor.

Investigation began before the collapse

Attention turned to Khouzame and his company on Good Friday last year, when a young family renting the home built less than 12 months earlier was woken at 4.30am by the sound of the ceiling collapsing.

Neighbours described hearing what sounded like an explosion as a portion of the house in Sydney’s south-west fell down, hitting several cars parked underneath. A previous tenant of the property said one room had earlier “completely flooded”.

But the collapse was less surprising to authorities, who had launched an urgent investigation into Hemisphere Constructions a month earlier. Only a day before, NSW Building Commissioner David Chandler had made an unannounced visit to a worksite in Concord operated by Hemisphere Constructions and found what he described as “pretty obvious” unsafe work practices.

“There is a strong correlation between unsafe worksites and the potential for serious defects to be incorporated in the project,” he told the ABC.

After cancelling Hemisphere’s building licence the following month, Fair Trading, the predecessor to Building Commission NSW, and investigators from Bankstown Police spent the year looking into the company. By January, they were ready to arrest Khouzame.

On visiting multiple homes connected to him, they encountered a problem: Khouzame was nowhere to be found.

After another month of searching, NSW Police obtained an arrest warrant and appealed to the public to find the wanted man.

“George Khouzame, aged 34, is wanted on an outstanding warrant in relation to fraud offences,” NSW Police posted on social media. “Anyone with information into his whereabouts is urged to not … approach him but to call triple zero (000) immediately.”

He handed himself in at Bankstown Police Station at 5.30am on March 6, and was arrested on the spot.

‘You should be saying thank you’

The builder in May pleaded guilty to the offences relating to his management of homes in Punchbowl, Macquarie Fields and Chester Hill.

At two of the three sites, Khouzame significantly understated how much his building projects were worth on insurance applications.

For a Macquarie Fields dual occupancy construction project worth $900,000, Khouzame was accused of writing in his Home Building Warranty Insurance that it was worth $520,000.

“Had the correct value of construction been stated on both insurance applications the value of the insurance premiums would have totalled $14,799.00 creating a deficit of $7517.94,” the facts tendered to the court read.

For a home renovation in Punchbowl, Khouzame listed the construction value to the insurance provider as $150,000 instead of $400,000.

He also pleaded guilty to engaging an unlicensed contractor to install windows and doors at a site he was renovating in Chester Hill.

Khouzame, who called the Herald on Wednesday from a private phone number after numerous attempts to contact him for comment, said the offences were “all they [the investigators] could come up with over a 10-year investigation and 350 homes”.

“The charges were dismissed in relation to the fraud and I pled guilty to only one charge for the home warranty application,” he said. “OK buddy?”

But after the Herald read out his nine offences, to which he pleaded guilty and was fined a total of $5450, Khouzame repeated his claim that it was “very minor fraud”.

“We failed, our staff failed, to update the home warranty to reflect the variations [in project costs] … It was just negligence from my office, and I did accept it, and I apologised.

“So we had existing 24 open projects when the house collapse happened and the licence was cancelled, and we paid out every single home owner and every single client.

“I didn’t run away from the problem. I approached the problem head on and I [had] done what I had to do to make sure that every client and every home owner has been supported by me personally.

“You should be saying, ‘Thank you, good work’.”

In its first six months, Building Commission NSW has cancelled, suspended or disqualified 136 construction licences.

“We’re starting to see the dividends of the expansion of powers the NSW government provided to the Building Commission,” Building Minister Anoulack Chanthivong said.

“It now has an expanded tool kit to improve build quality and weed out those who don’t play by the rules.

“Already this year, we’ve had a nearly 100 per cent increase in the number of building work rectification orders issued, helping to deliver compliant, safe and trustworthy homes.”

Chanthivong did not respond to questions about why charges had not been laid over the house collapse.

With his licence suspended, Khouzame is now working as a labourer for a friend’s food company.

 

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Cheaper EVs?

20 April 2024

Here is an article praising China’s Electric Vehicle industry and noting that Apple gave up trying to do EVs and China has successfully taken up the slack.

It also boasts that Chinese EV technology is excellent and that they have not lowered prices, and it warns that trade tariffs to stop Chinese exports will be counterproductive.

More conventional views are that China has a glut of EVs and a coming economic crisis due to their property bubble.

Australia has no tariffs on EVs and is currently paying too much for them.  Despite the tone of this article, China must want to dump EVs somewhere.

I am still not sure that EVs are good for the environment in that the carbon footprint from mining and processing their components is much greater than the simpler components of internal combustion engines, and the factories that manufacture them are mainly powered by coal-generated power.  It takes many km of petrol saved to overcome this initial deficit. Hopefully this situation will gradually improve in time, but in the shorter term, will Chinese EVs be cheaper here?

What does China’s electric vehicle rise mean for the global market?

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Labor’s Policy Drift

20 April 2024

Albanese won the Federal election 2 years ago, but he has been very disappointing.

Australia wanted real change after a decade of Liberals doing nothing except giving money to their mates, offending China and pursuing the dubious AUKUS strategy, (a $360 billion photo op for Scott Morrison).

Labor was very dejected after a bold policy platform from Bill Shorten fell to a characteristic Liberal scare campaign from Scott Morrison in the 2019 Federal election, so they pursued a ‘small target’ strategy (i.e. minimal policies) in the 2022 election.

But when they won the 2022 election, they have still been scared to do anything, behaving like Liberal-lite, as if they are still scared of any Liberal criticism.  It seems that they believe that negative political campaigning is so much more successful than actual policies that they are best served by giving the Liberal little to criticise, i.e doing very little. The Liberals are ruling from beyond the grave.

Labor did not undo the Liberal follies of the AUKUS pact, the kow-towing to the US with their bases here and silly behaviour in the South China sea. (How would the US feel if China took a few aircraft carriers for trips around the Caribbean just to emphasise freedom of navigation?) They even kept the Stage 3 tax cuts, which were a desperate Liberal measure; a future promise to win a present election. Labor promised no tax increases, so Medicare remains doomed, and the long-term privatisation contracts that the Liberal installed in Centrelink remain, with our welfare system behaving like a suspicious private insurer as jobs and job security become more tenuous.  They were petty with the Teals, taking their staff when they should have supported them both because they are more aligned to Labor in many policy areas, and because they are all from Liberal seats and it is in Labor’s interest that the Teals have them rather than the Liberals.

Now we have dubious rumblings about subsidies to Australian manufacturing with lots of patriotic tub-thumping.

My own view is that Albanese is quite safe in his job until at least after the 2025 election, but Labor may lose seats to Greens or independents if he does not do more of what is needed.

Dutton plays to his base while Albanese neglects his

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Gaza- Where Next?

10 April 2024

The world has watched in horror and amazement as Israel has systematically bombed Gaza.

Gaza was an open-air prison in the sense that its people could not move without permission, could not trade, except via Israel so had no industry and even their food supply was controlled.  This led to the rise of Hamas, which was seen as at least willing to stand up to Israel rather than being the patsies of the Palestinian Authority (more on that later).  Hamas was a result of the situation, not the cause.

 

As I  have posted before, Israel was making friends with most of the countries around it. Jordan was too weak to stand up to it, as was Egypt. Qatar and UAE were mainly interested in trade, and Saudi Arabia, despite being strongly Sunni Muslims were about to sign a treaty.  Netanyahu was captive of his religious Right and talking about a ‘Regional Solution’ for the Palestinians.  This was probably code for them ‘going elsewhere’.

 

The State of Israel was ‘declared’ by Ben Gurion in 1948. The slogan had been ‘a land without a people for a people without a land’.  Palestine had been a colonial state, part of the Ottoman Empire and then, after WW1, a British Protectorate and. But this did not mean that it did not have people occupying it.  The state of Israel set about populating it by putting ‘settlers’ on the West Bank. The myth was that this land was not owned, which was only legally correct because Israel did not recognise land title prior to the declaration of the State of Israel. So Palestinians did not ‘own’ the land that they had occupied for decades.  The ‘settlers’ were given land on the hilltops that the Palestinians were driven off, and the Israeli defence force guaranteed them support if the Palestinians, now defined as terrorists, attacked. A network of roads was built so that the army could come quickly to quell any Palestinian ‘aggression’.  Many of the settlers came from Eastern Europe and had been marginalised in their previous countries so defending their Jewish status and new homes was not a huge conceptual step.

 

This went on for years with unsuccessful negotiations for a ‘two state’ solution with Yasser Arafat. The Palestinians were portrayed as terrorists while Israel gradually made the two state solution impossible on the ground. The settlers were educated principally in Hebrew which reinforced their Jewishness, but also limited their information input and their options to go elsewhere.  There are now about 750,000 of them, so the West Bank is effectively ‘occupied’ and the settlers will not move any more than the Palestinians want to.

 

Israel also created Ramullah as the so-called capital of the supposedly-coming Palestinian state.  The international aid agencies moved there, naturally wanting good premises for their staff to live and work and the price of rents and real estate there meant that the Palestinians, on minimal income, had trouble living there. The Palestinian Authority, now actually having a place to rule, could approve land developments, a handy source of income and also of corruption. So the Palestinian Authority was no longer seen as the legitimate rulers, but as compromised by Israel, which is why Hamas won the Gaza elections.  Palestinians are generally not a particularly religious people.

 

The Palestinains are forced out of their accommodation in Jerusalem by the fact that increasingly Israelis use imported labour from Sri Lanka to do the menial jobs that the Palestinians used to do. So they had no work and could not pay the rents. If they left the house, under Israeli law an unoccupied house belongs to the State and can be gifted to a settler, so there has been a constant house by house clearing of Palestinians from Jerusalem, both the old walled (holy) city and the new part where traditionally Palestinians have lived on the East Side. So the Palesitinaisn were gradually getting to a situation where they had no land and no jobs. They were portrayed as terrorists and there was no negotiation towards any sort of lasting settlement.

 

Hamas probably launched the October 7 attack because if it did not do so, the Palestinian people had no future.

 

Israel, with Netanyahu having to stay in power at a personal level because of corruption charges and hostage to the religious Right first bombed the north of Gaza, and now, 35,000 or more deaths later, is intending to invade the last part where 1 million refugees have gathered.  It may be that the religious Right simply want all the Palestinians dead. In Biblical times whole cities were massacred,so it is hard to know their frame of reference.  It seems quite probable that the Israelis assumed that the border would be opened, the Palestinians would flee to a refugee area in the Sinai and they would never be allowed to return, creating a ‘refugee crisis’ which would be a UN rather than an Israeli problem. Israel would have solved its problem, and the precedent would let the West Bank Palestinains follow the Gazans. Unpopular in the short-term, but a ‘regional solution’.

 

The Israelis were keen to maximise harm to the Gazans, not allowing food trucks in, and the West talked about building ports to get food to Gazans rather than try to stop the Israeli blockade.  It is hard to believe that the food trucks that were negotiating directly with the IDF (Israeli Defence Force) were hit accidentally; rather it was part of the overall strategy to discourage the aid, stop the Gazans getting fed, worsen their plight and get them to go elsewhere.

 

The idea that hunting Hamas militants is a serious strategy must be dismissed as nonsense. This will not be won as a military campaign. The hate sown by this action will last for generations. But why should Israel be believed when it says that this is its strategy?  They took the West Bank by stealth as they claimed that they wanted to negotiate peace. It  was simply a lie. They have worked for 40 years to make a ‘two state solution’ impossible. Now, amazingly even the Australian government thinks this can be achieved.  There are $750,000 settlers making it impossible.  Jeff Halper, an American Jewish anthropologist who moved to Israel wrote an excellent book in 2010, ‘An Israeli in Palestine’ in which he advocated a ‘One State solution’ on the assumption that the apartheid situation that exists has to be undone as it was in South Africa. This looks a very dismal prospect now. When I visited in 2012 the average Israeli was in a state of denial about what was happening, regarding it as the army and the police’s job to keep the peace so that they could continue ‘normal life’.  It was strikingly similar to the situation when I had visited apartheid South Africa in 1985.  Now the Israeli population is very scared and arming themselves. It will end up like the US with a large number of gun-related deaths and the problems ongoing. In the end a society has to be built on consensus and a degree of trust between individuals and strangers.

 

So what of the Gaza war? I have drifted off topic.  The actual fighting has had very little attention. Do the Israelis merely bomb the city systematically and then walk in over the rubble with few casualties? Is Hamas actually fighting? There seems to be no attention to this in the mainstream press. And what of the Israelis?  A million people are demonstrating for a change of government, but it seems unclear what they want. Their hostages back?  A cease fire? A reasonable long term peace?  On what terms?

 

Netanyahu has said that a date is set to invade the rest of Gaza. Does this mean even more casualties than before to force the world to take the Gazans as there is nowhere else for them to go? It looks that way.

 

Even if the world stops supplying weapons, will the Israelis have enough stockpiled to complete the job?

 

And if the Israelis stop, either now or after even more carnage, how will Gaza be rebuilt or there be any sort of just solution for the Palestinians?

 

The world sees Israel as the last and most brutal of the colonial powers, simply taking a land and killing inhabitants who resist. The developed West with all its talk of international law is seen in the global South as hypocrites, unwilling even to condemn a more recent colonial aggressor.  It is hard not to see their point. Countries are judged by what their governments do, not by what their people may think. Australia’s late foray into arms manufacture with the Israeli partnership can be seen for the stupidity it was. We are all losers here. Recognition of a Palestinian state will at least elevate the status of any Palestinian  negotiators. It is too little too late, but what are the alternatives?

 

https://theconversation.com/penny-wong-floats-recognising-palestine-ahead-of-two-state-solution-to-help-path-to-peace-227456

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The Australia Card and Data

16 March 2024

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Australia Card anyone?

 

How the digital world is getting better at measuring us up

Ross Gittins, Economics Editor

SMH March 15, 2024

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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AUKUS- time to make a RUcKUS

6 February 2024

The decision to buy Australia nuclear submarines was one of the worst military decisions ever taken in Australia, not to mention the opportunity cost of $360 billion in terms of the useful things it could do to improve Australian society.

Nick Deane of the Marrickville Peace Group punches well above his weight because of the dire state of peace activism in Australia. He writes excellent material in a very understudied area.

He makes the point that a few submarines cannot defend Australia if it were in danger of a serious attack. But of course that much money could buy a lot of other military material, so we are actually a lot weaker for having the subs.

The other reason given is ‘deterrence’. Presumably this relates to China, but given the huge arsenal the US already has, whether a few submarines are Australian-flagged or US-flagged will not change their thinking one iota.  China is a power that is going to rise whether we like it or not, their current economic problems notwithstanding. Anwar Ibrahim, the excellent Malaysian Prime Minister has pointed this out at the ASEAN meeting in Melbourne.

We are not going to stop China’s rise and we should try to get the US to accommodate this as they will not be able to stop it either. We should simply deal with China as a trading partner, not sell them our strategic assets and get a fair price for our wares.  Their interest in the Eurasian continental mass will be far greater than invading a farm and a quarry of far less economic significance.

My own view is that it quite dubious whether a nuclear submarine will be of any use in any case. The battleships that fought in WW1 were rendered totally obsolete by their vulnerability to seaplane attacks in WW2. Submarines can currently hide because changes in water temperature make them hard to detect.  Conventional submarines get found when they come up for air, but nuclear submarines can stay submerged for very long periods. But nuclear submarines produce a lot of hot water from their reactors, which they cannot turn off. If they stay in the same place quite a plume of hot water goes up from them.  It is hard to believe that satellites will not be able to notice this temperature difference.  The Russian Black Sea fleet is being sunk by numerous relatively cheap drones, and it is difficult to believe that a pattern of surface drones guided by a satellite would not be able to locate and then destroy a submarine twenty years hence.

The UK wants to sell us submarines and wants to lock us in on their side in a confrontation with China. But the  US has other objectives. Apart from selling us submarines at vast profit, we will have to have a base capable of supporting them. Then they will be able to use that base, presumably at minimal cost, so we are locked into having US nuclear warships in our ports at our cost and becoming targets for China in the confrontation.

The pro-nuclear lobby has also pointed out that Australia will also have to hugely expand our nuclear knowledge capability with at least another reactor larger than our modest one at Lucas Heights. We cannot just have submarines and not be able to operate and maintain them.

The defence procurement has been an a mess for years, one suspects because some of our strategic planners want us to ‘operate seamlessly’ with the US, which assumes that our military policy is in total lockstep with theirs, and other planners want an independent Australian capability, fearing the US under Trump  might go into isolationism as it did just before both world wars. What do you procure if you have not solved this internal wrangle?

So along comes Morrison whose popularity is sagging just before an election and makes a big decision that allows him to pretend he is a big statesman with a US President and a UK Prime Minister. Photo op a bargain at $360 billion!

Labor, ever-fearful of being criticised by the Liberals for being ‘weak on defence’ (or border security or tax cuts) has just gone along with this. And of course decades of dithering for the reasons above have meant that there is no properly thought out and costed alternative.

We need to recognise that the US will always act in its own interest as it did in delaying its entry to WW1 and WW2 and in selling arms now. We need our own defence policy and to recognise that the US may help us, but only if it has the resources available at the time and there are not other priorities. Once we have a defence policy, we can  fix the muddled thinking and get a defence procurement strategy.  But we will have to make enough noise to get rid of the AUKUS deal, which will tie up so much money that nothing else will get a look in.

Here is Nick Deane’s article from John Menadue’s Pearls and Irritations:

 

How did Australia get seduced by AUKUS?

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The Law is a Dangerous Ass

3 March 2024
For some inexplicable reason, people seem to think that the legal systems in the Anglosphere are good or at least adequate. They have huge delays, cost a fortune and quite often come to absurd conclusions. I will leave the last point for the moment and just consider one of its most significant current delays.

Four years ago, the unsuccessful Presidential candidate, Donald Trump, did not accept the election result and encouraged his supporters to invade the Congress. People were killed.
Most people would call this a ‘Coup Attempt’.

Yet years later the legal system now has the US Supreme Court, some of whom were appointed by Trump, deciding whether an ex-President can be charged for encouraging a coup or can pardon himself if he is re-elected. The Supreme Court is not expected to be able to come to a conclusion by November, so 4 years after the attempted coup, Trump will get another go.

Would any non-Anglo country tolerate such absurd delays? If it happened in a South American country our media would lampoon their system. The headline would be ‘Coup Leader Walks Free’ or similar.

You may have seen the 4 Corners of 26 February where a reporter tracked down an alleged Rwandan genocider living in Brisbane and wondered about his extradition and the Australian legal system’s response. Part of that program was a discussion of how the Rwandans had used a form of community discussion justice to punish the genociders, give them sentences and achieve a national reconciliation between the tribes. It was food for thought.

We all say the ‘The law must take its course’ or ‘Due process must be followed’. It is time someone said, ‘Processes that take more than 4 years to call a revolutionary coup leader to account are not satisfactory’, or ‘Exaggerated respect for this unsuccessful legal system may give the whole Western world the leader that destroys it’, and actually did something about it.

Here is an article in today’s Sun Herald pointing out that Trump is still likely to be able to stand in the elections. It is pretty wordy.

Anyone who hopes to see Trump in prison soon will be disappointed

The Economist- in Sun Herald 3 March 2024
The flimsiest of the cases is set to go first, and all face delays or uncertain penalties.
The prosecutors trying to convict Donald Trump face a highly unusual deadline. Retaking the presidency would offer Trump his best escape from jeopardy: once back in the White House, he would be able to squelch or pause the four criminal cases lodged against him. Hence prosecutors’ urgency – and a public interest – in concluding those trials before November. Miss that opportunity and he may never be held accountable in a court of law for his alleged crimes.
The 91 felony charges against Trump are both serious and picaresque. The weightiest are related to his role in the attack on the Capitol on January 6, 2021. His attempt to overturn his defeat in the 2020 election was the most shocking and serious assault on the constitution in decades, if not since the civil war; whether a jury would see Trump as guilty or innocent has obvious salience as voters prepare to decide whether to return him to the presidency. There are additional allegations about election interference in Georgia and the mishandling of state secrets. And, there is also a plot involving a payment to a porn star.
Trump insists he has done nothing wrong in any of the cases discussed in this article, and has so far incorporated all of them deftly into his restoration narrative of victimhood and revenge seeking. The fact that two of the criminal indictments were brought by district attorneys elected to their offices as Democrats has provided ballast for his claims that he is being targeted by political enemies.
Still, he will frequently appear before judges as an accused felon over the remaining eight months of the campaign. Indeed, Americans are already growing accustomed to a splitscreen of scowling courtroom appearances and Make America Great Again rallies that has no precedent in past presidential elections.
Yet, Democrats who wish to see him locked up by election day will be disappointed. It seems probable that at most one or two trials will conclude before voting starts, and even if the former president is convicted of one or more felonies, he is likely to avoid or at least delay a prison term until after the election is decided.
A trial in the January 6 case could take place in the US summer or early autumn, depending on how Trump’s appeals unfold. If it does go forward during the campaign, wall-to-wall news coverage will refresh memories of how Trump’s Big Lie and his attempt to stop Congress from certifying the vote led hundreds of his supporters to storm the Capitol. Five people died as a result of the attack and more than 150 police officers were injured.
However, instead of a trial-of-thecentury about an event of plain historical significance, the flimsiest of the four cases may go forward first. That trial is scheduled for March 25 in Manhattan.
Alvin Bragg, a Democrat who is the borough’s elected district attorney, brought an indictment that does not lack ambition. Trump stands accused of 34 felonies for falsifying business records to hide hush money paid to Stormy Daniels, a porn actress, before the 2016 election. Prosecutors allege that Trump ordered his lawyer, Michael Cohen, to buy Daniels’s silence for $US130,000. After he won the election he reimbursed Cohen and marked those payments as legal expenses.
FIRST BUT NOT FOREMOST
The case is convoluted. Normally, the charge would be a misdemeanour. To elevate it to a felony, prosecutors must prove the records were falsified with intent to commit another crime. Bragg has alluded to several other offences in legal filings. He could say the payments violated federal campaign finance laws since they were not declared as contributions, or that taxes were not paid on them.
Bragg’s case falls in a legal grey area. Federal election law pre-empts state prosecutors from bringing cases about federal races. By pursuing an untested legal theory, Bragg has bolstered Trump’s claim that he is the target of a partisan prosecution, says Jed Shugerman of Boston University School of Law.
There are other problems with Bragg’s case. The star witness, Cohen, lacks credibility, having lied to Congress and a federal judge. The carnivalesque nature of the trial – a former tabloid publisher and a former Playboy model will probably testify will play to Trump’s advantage, making the case seem like reality TV, a format in which he is highly practised. Even if Trump is convicted, there seems to be little chance that the judge would sentence him to prison on such novel charges involving the manipulation of records.
A BIG QUESTION MARK
The January 6 case was lodged in federal court in Washington DC by Jack Smith, a special counsel in the Department of Justice (DOJ). Smith charged Trump with four crimes, including conspiracy to defraud the United States and to deny voters their rights by using lies, ‘‘fake’’ electors and other schemes to thwart the lawful certification of the electoral-college vote by Congress on January 6. The indictment was tight, conservative and designed to move quickly, says Ryan Goodman of New York University School of Law. Though it lists six alleged co-conspirators, only Trump was charged. (The others may be later.) No count relates directly to the violence of the Capitol riot. That would have been a heavier lift for prosecutors.
A charge of insurrection or seditious conspiracy – used to convict a number of far-right militia leaders who stormed the Capitol – would have required proof that Trump knew the protests that day would turn violent. Incitement would have elicited a potentially strong First Amendment defence. Still, Smith will need to show criminal intent. Trump’s lawyers contend that he genuinely believed he won and that advisers said his pressure tactics were legal. That may not be a winning defence: plenty of people repeatedly told him he had lost. But it is a viable one. Rebecca Roiphe of New York Law School cautions against calling the case rock-solid.
The biggest question mark is the trial’s timing. Initially, the presiding judge, Tanya Chutkan, an Obama appointee, moved the case along quickly. But in mid-December she froze trial preparation so that Trump could argue in a federal appeals court that the case should be thrown out on presidential-immunity grounds. A three-judge appellate panel unanimously rejected his request earlier this month. The Supreme Court agreed to hear the case this week, adding a delay of perhaps months.
By July at the latest, Judge Chutkan should have a green light from the Supreme Court to unfreeze the proceedings. (Hardly anyone expects the justices to side with Trump on immunity.) Several weeks of preparation will need to be recouped before the trial actually gets under way. Then the trial itself will take about two to three months. That gives decent odds of a verdict by election day.
If Trump is convicted, sentencing will be up to Judge Chutkan. She has required prison time for every convicted Capitol rioter whose trial she has overseen. But that seems highly unlikely for a former president. A more plausible scenario would be a fine, probation or house arrest. In any event, he would remain free while he appealed against the conviction.
THE GEORGIA AFFAIR
If Smith’s federal indictment over election interference is a targeted harpoon, its state counterpart in Fulton County, Georgia, is a giant trawl net. Both rely in essence on the same facts and witnesses. The big difference is that Fani Willis, a Democrat who is the elected district attorney in Fulton County, named 18 co-defendants alongside Trump, whom she charged with 13 felonies. All were indicted under an anti-racketeering statute first used against the mafia. A conviction can result in prison time of five years or longer. Willis says she wants the trial to start in August and, given the number of co-defendants, expects it to run into 2025. Three have pleaded guilty so far.
But the case has been derailed by revelations of an affair between Willis and a lawyer she hired onto her team. The defendants want her disqualified, prompting a mini-trial about the nature of the relationship. They argue that Willis has a personal stake in prosecuting them, to see her paramour enriched – he made $US728,000 on the job, and paid for at least a share of the couple’s holidays together. Willis denies any impropriety and delivered combative testimony in her own defence at a hearing on February 15.
If the judge, Scott McAfee, disqualifies her, a state agency will appoint a new prosecutor, which could take a year or more. Her replacement could alter or even dismiss the charges. Even if Judge McAfee lets her stay, he will probably allow the defendants to appeal against his decision and pause the case. Don’t bank on a trial before the election, in other words.
STRAIGHTFORWARD BUT SLOW
On the face of it, the case brought by Smith involving Trump’s alleged mishandling of classified documents is the most straightforward. But the judge randomly assigned to the case, Aileen Cannon, who was appointed to the bench by Trump, has moved slowly, and there appears to be little chance that it will reach trial before November.
Here the facts and the law are uncomplicated. Federal prosecutors charged Trump with 40 felonies over his alleged wilful retention of national defence papers and his refusal to give them back. According to prosecutors, after Trump left the White House, he ordered aides to hide dozens of classified documents from the FBI. They were caught on video shuffling boxes.
Trump appears to have misled his own lawyers, who certified to investigators that everything had been handed over. It took a raid on Mara-Lago, his Florida estate, to get them back. Some dealt with America’s nuclear arsenal. Trump is said to have twice shown documents to visitors and acknowledged that they contained secrets.
What makes the case thorny has less to do with its merits than with procedural hold-ups. In national security prosecutions the government tries its best to withhold classified evidence from the defence, not to mention jurors. The judge decides what material has to be disclosed and to whom; those decisions are contentious and can be appealed against. The backand-forth means delays.
Whenever the trial does start, it will be held in Trump’s backyard in Florida and could draw a sympathetic jury. A single holdout juror can block criminal convictions, which require unanimity in America. Even if he is convicted, sentencing will be up to Judge Cannon. In normal circumstances someone found guilty of the alleged crimes would risk going to prison for a few years. But again that seems unlikely in this instance.
I BEG MY PARDON?
Say Trump wins in November and gets convicted and sentenced in any of the four cases before taking office: what then? If he is convicted in either of the two federal cases, he will appeal. After the inauguration he might try to pardon himself, or better yet issue a blanket prospective self-pardon. (His attempt to pardon himself would not help him in either of the state cases, since presidential pardons do not cover state crimes.) No president has ever attempted that. When Richard Nixon contemplated it during the Watergate scandal, the DOJ said it was improper and he was let off by his successor, Gerald Ford. In any event, the Supreme Court would have the last word.
A surer bet would be for Trump to appeal against his conviction, and then, while the case was winding through higher courts, order his attorney-general to drop it. Again, that trick would not work in Georgia or New York, since state cases sit outside the Justice Department’s purview. Yet DOJ policy says a sitting president cannot be prosecuted, and while the advisory opinion is unclear about state matters, it seems likely that all of Trump’s criminal cases would be paused while he held the presidency. Prosecutions might resume in 2029 when he leaves the White House. At that point, he would be 82.
Trump is partly right about the charges he faces. They are political – not in the sense that the cases are partisan attacks, but because of how they may or may not change America’s political trajectory. Over the next eight months the American justice system will be tested by Trump’s defiance and delay. How that system performs will provide a measure of its own integrity and resilience.
It will also determine whether a candidate who sneers at the rule of law is able to manoeuvre his way past the charges against him long enough to win in November and become a law unto himself.
The Economist

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‘Health Policy’

Chesterfield-Evans, A. (2024)

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

HEALTH POLICY

Arthur Chesterfield-Evans

Just before the 2022 federal election, Mark Butler, now the Minister for
Health in the Albanese government, spoke to the National Press Club,
praising the courage of the Hawke government in creating Medicare in
1984. His speech also set modest priorities for a prospective Labor
government, committing to (1) improve the digital health record and make
the MyHealth record actually useful; (2) develop multidisciplinary care;
(3) establish a new funding model for ‘MyMedicare’; and (4) grow the
medical workforce, with special mention of nurses and pharmacists (Butler
2022). Significantly, Butler did not commit afresh to Medicare as a
universal health scheme free at the point of delivery, the key element of
the original 1984 scheme that he praised. In an environment where,
politically, it seems that taxes cannot be increased, perhaps this ideal may
be an impossibility, but it is surely significant that it is no longer stated as
an aspiration.

Currently, Medicare is quietly dying as the low rebates cause doctors to
abandon it. Australia is moving to a US-type private system by
default. This has resulted in large amounts of hand-wringing rhetoric, but
so far little action. This short article comments on the changes initiated by
the current Labor government during its first year and a half, contrasting
these with the deep-seated problems needing to be addressed if better
health outcomes are to be achieved.

Labor’s reforms

The government has made some minor changes to Medicare which came
in with great fanfare on November 1, 2023. There were new item numbers

for new specialist technologies or treatments and an increased Medicare
rebate for GPs, up to $41.40 for a standard visit for a RACGP member,
which is 40.6% of the AMA fee. Doctors without the RACGP qualification
still get $21, which is 20.6% of the $102 AMA fee.

When Medicare was born, the Medicare rebate was 85% of the AMA fee.
The rebate has risen at half the inflation rate for 39 years, so doctors now
feel ripped off every time they see a Medicare patient. Labor blames the
disparity on the rebate freezes of the previous LNP Coalition governments,
but its own record is poor. Successive governments of all types have
deferred to the private health lobby and are starving Medicare, slowly
defaulting towards a principally private system, as in the USA. This is a
deeply-troubling prospect because the US health system has been
recurrently criticised (Commonwealth Fund 2021) – and rightly so –
because it makes access to health care dependent on ability to pay. Notably,
however, it is the world’s best system at turning sickness into money.

The other recent Labor ‘reform’ was to allow pharmacists to process
prescribed medications to cover patients’ requirements for 60 days, rather
than 30 days, thereby halving the costs of prescribing and dispensing.
While this may seem helpful, patients are often confused by complicated
generic names and generic brands; and compliance or discontinuation of
medicines is a largely unquantified problem. These are existing problems
with the current arrangements for dispensing medications: the recent
policy change, while well-intentioned, does not redress them. It transfers
resources from professional staff to the pharmaceutical industry.

The ‘Strengthening Medicare Taskforce’ had good medical and allied
health representatives and support. Its December 2022 report defined the
problems but, trying to avoid controversy, positive suggestions were thin
on the ground. A deeper analysis and more comprehensive approach to the
redress of health issues is needed.

Basic problems in the health system

Diverse funding sources causes cost-shifting

Fundamentally, no-one is in overall control of the health system. It has a
number of different funding sources: the Federal and State governments,
the Private Health Insurance industry (PHI), Medicare and individuals

themselves. Workers Compensation (WC) and Compulsory Third Party
(CTP) insurers also put in a bit. These arrangements lead to a situation
where each funding entity attempts to shift costs without any real care for
the overall cost of the system. Private entities such as pathology and
radiology also have an interest in providing more services, whether they
are needed or not.

The broad division of the health system is that public hospitals and
emergency departments (EDs) are State-funded, and non-hospital services
are Federally, PHI or self (patient) funded. There is some overlap,
however, because the State’s provision of some community-based services
allows them to save on hospital-bed days; and private funds paid to State
hospital in-patients are eagerly sought. The starvation of Medicare (which
reduces the Federal government’s spending) has resulted in more patients
going to EDs at higher (State) cost, as well as increasing PHI and patient
costs.

This cost-shifting has evident implications for the affordability of health
care: notably, a recent study showed that Australia, when compared to 10
other countries, scored poorly on its measure of affordability
(Commonwealth Fund 2021).


A new health paradigm is needed

Yet more fundamentally, there is a huge problem with the conceptual
model of the health system. In common parlance, the ‘health system’ is the
‘paying to treat illness’ system. Paying doctors to see and treat patients is
seen as the major cost and is the most politically fraught element in the
system.

Historically, everyone was assumed to be healthy and had episodes of
either infectious diseases or surgical problems. They went into a hospital
for a brief period and either recovered or died. The legacy of this is that
heroic interventions are over-resourced and the more cost-effective early
interventions are under-resourced.

Infectious disease is now relatively uncommon, notwithstanding the recent
and ongoing coronavirus concerns. Most disease is chronic; and the
objective is to maintain health for as long as possible and to support those
who need support in the community rather than in institutions. ‘Health’
must be re-defined as a state of physical and mental wellbeing; and
maintaining it as ‘demand management’ for the treatment system.

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


Hierarchies, cartels and corporatisation

The medical system is hierarchical with specialists at the top and GPs at
the bottom. The specialist colleges have produced less practitioners than
would have been optimal. The starvation of General Practice has led to
increasing specialist referrals for simple procedures. Most patients are
happy to go along with this, though often much less happy about the rising
costs. Practitioners tend to work down to their station rather than up to
their capacity. GPs, if given the appropriate additional education and
empowered to act, could do what quite a lot of specialists do now, while
nurses could take the load from GPs; and, in terms of home support, a more
comprehensive and flexible workforce needs to be developed.

Private medical insurance systems are a further source of problems. They
have marketing, churn, profits, liability and fraud issues; and they make it
necessary to account for every item of every procedure. While the
corporations watch every cost, the regulator cannot. Corporations buy
medical practices and take up to 55% of the gross revenue. Smaller
radiology practices are being gobbled up as investments (Cranston 2020).
If overheads are defined as the amount of money put in compared to the
amount paid for treatments, Medicare costs about 5% and PHIs, as they
are regulated in Australia, about 12%. In the USA, the private health funds
take up to 35%, and Australia’s CTP system got close to 50%. A universal
health insurance system could avoid many of these costs and would be far
superior from a social equity point of view.

Similar problems are evident in the provision of care for people with
disabilities. Labor pioneered the NDIS when last in office a decade ago,
and rightly claims this as evidence of its commitment to redress the
previous neglect. However, the NDIS can be considered as a privatisation
of the welfare system. It overlaps medical system functions and is poorly
regulated. If its efficiency is judged by the percentage of money put in that
is paid to the actual workers delivering the service, care is not very

efficient. There have also been significant criminal rip-offs (Galloway
2023).

Retirement care arrangements have major flaws too. Aged-care
accommodation is largely driven by the real estate industry; and access to
continuing care is an add-on of often dubious quality.

What should the government do?

The problems described above are diverse, deep-seated and not easily
rectified. However, a government intent on staying in office for a series of
terms could heed the call for some big thinking, drawing on the experience
of health practitioners themselves. Here is a list of what might be done,
becoming more medical and more politically difficult as it progresses:

Keep people healthy with education, clean water, sanitation, housing,
good food, regular exercise, high vaccination rates, road safety,
universal swimming lessons, CPR and first aid training and the active
discouragement of smoking, vaping, alcohol and drug use, junk food
and gambling.

Provide housing with graded community support options for those
people with disadvantage or impairment. Create a registration and
insurance system for home and community support services, so that
individuals can buy standardised services from other individuals.

Maintain fixed staff-patient ratios related to the disability
classification of residents in institutional care.

Make maximum use of community and school interventions and
support services such as District and Community nurses and School
nurses, mental health support networks, Aged Care Assessment
Teams, Hospitals in the Home etc.

Address health problems as early and as low down the support and
treatment hierarchy as possible, by empowering those who provide
the services.

Create a meaningful regulatory, inspection and enforcement system
for support services, both community and residential, and for
workplaces and recreational facilities.

Use the medical information system to research drug and treatment
effectiveness.
Support General Practitioners and try to increase their ability to solve
problems without referral. Have GPs work in Health Centres with
community support workers as far as possible; and improve
communication with data collection a by-product of normal work, not
an additional imposition.

Have independent evaluation of the numbers needed in the specialties
and pressure the colleges to provide these numbers. Use waiting times
as an initial index.

Initiate either university-based or college-based continuing medical or
professional education, with mandatory refresher exams every
decade.

Have universal professional indemnity insurance, with doctors and
other health professionals unable to be sued if they report all incidents
of sub-optimal outcomes within 48 hours of becoming aware of them,
and participate in regular quality control meetings.

Publicise and promote organ donation, end of life plans, wills and
enduring powers of attorney as sensible steps in life-management.

Evaluate Intensive Care interventions in QALY (Quality-Adjusted
Life Years) terms, researching their outcomes and comparing them to
earlier intervention initiatives.

Change the composition of the Pharmaceutical Benefits Advisory
Committee so that it has no pharmaceutical industry representative on
it; and remove ministerial discretion from its decisions. The previous
system evaluated new drug listing approvals with a cost-benefit
analysis (Doran et al. 2008), but the Howard reforms of 2007,
following the Australia-US Free Trade Agreement and lobbying by
Pfizer, put a drug industry representative on this committee, making
its negotiations more transparent and thus more difficult for the PBS
to negotiate prices (Access to Medicine Working Group 2007).

Work towards replacing Workers Compensation and CTP insurance
schemes with income guarantee schemes (this will only be possible
when Medicare allows timely treatment).

Create a credible and indexed scheme for paying medical
professionals which does not have KPIs that distort performance.
Make Medicare a universal taxpayer funded health system that is free
at the point of delivery and stop subsidising PHI. It might be noted
that the Government currently quotes Medicare and PHI costs
together as a sum rather than itemising the two, which serves to
disguise the subsidy to PHI (Parliament of Australia 2022).

Conclusion
The current federal Labor government has made statements about health
policy reform and done minor tinkering during the first year and a half in
office. Based on this start, it is doubtful that it will have the courage to
make the necessary major changes, addressing the systemic problems.
Fine rhetoric is unlikely to achieve much. That makes it doubly important
to develop proposals for more fundamental reform. Written with this
intention, the suggestions made in this article could be the basis for
tackling the fundamental institutional and political economic issues
problems associated with personal and societal ill-health.

Dr Arthur Chesterfield-Evans trained as a surgeon in Sydney and the UK
and is a Fellow of the Royal College of Surgeons. He currently works as a
GP with interests in workers’ compensation and third-party injury. He has
been a tobacco activist and an elected member of the upper house of the
NSW Parliament. He has Master’s degrees in Occupational Health and in
Political Economy.

chesterfieldevans@gmail.com

References

Butler, M. (2022) ‘Address to National Press Club, 2 May,’ available:

www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-
care-speech-national-press-club-2-may-2023.

Commonwealth Fund (2021) US Report, available:
www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-
reflecting-poorly.

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