Doctor and activist
17/07/2017
17 July 2017 I have recently visited Poland and wanted to record some impression while they are fresh in my mind. I had previously visited Poland in 1989, which was only a few months before the Berlin Wall came down with the collapse of the USSR under Gorbachev. This had immense implications for Poland, and […]
01/07/2017
1 July 2017 I have grave fears for this system. I am unsure even of the goodwill of some of its advocates. I was on the Social Issues Committee of the NSW Parliament and we looked at Disability services and the way that these were delivered. Basically if you ask how big the disability problem […]
15/05/2017
15 May 2017
Since the last two world wars were over markets, it was assumed at the conference at Bretton Woods that if there were free markets everywhere there would be no wars and countries who did well would prosper. It worked. Germany and Japan traded in markets that had been denied to them pre-war and ‘won the peace’. The dogma was that because there was efficiency in production we would all be better off as goods would be available all over the world quickly and cheaply. And, helped by the overwhelming dominance of Milton Friedman’s economic theories the market has spread into every aspect of life. The fact that when Friedman’s theories were actually implemented in South America that they failed miserably was merely a blip ignored.
Now the market is assumed to be better than anything else as a way of allocating resources efficiently. It is better than government, better than planning, hey it is infallible, and probably inevitable as well!
Governments do not have to manage anything; they can sell it, even if they do not need the money. Inner city buses are the latest.
If you read Chapter One of most economics books, it tells you about competition and how you cannot charge too much or a competitor will uncut you, so prices are kept down.
The rest of the economics book tells about monopolies or oligopolies, where there is poor competition and you can charge what you like, or there are high set up costs as barriers to competition, or regulatory hurdles, artificial training or registration requirements, geographical limitation, existing facilities, impractical duplication costs etc etc, which make monopoly or ‘supernormal’ profits a certainty. Yet Governments plough on creating private monopolies and compliant political parties are rewarded by campaign funding to keep on winning elections.
What I am writing is not new or original and is known by anyone with even the most basic grasp of economic theory. Do the politicians not read past Chapter One? Do they never think that they are creating uncontrolled monopolies as they transfer assets from ownership by all the society to ownership by a moneyed elite? Are they so ideologically committed to privatisation that they no longer think at all? Do they not care, or will they do anything for their own short-term interest? It seems that the answer to all these questions is YES!
They have sold the airport, the sea port, the water supply (an endless subsidy to an unused desalination plant), the railways, the electricity, the road network and easements under it, the world standard database of land titles registration, the small councils power to control development, the list goes on and on. The health system is being sold by stealth. Medicare is being starved to death, as private health insurance is just subsidised inefficiency, and NDIS disability services will go the same way, no government services, oligopolies for profit paid for by the ‘Medicare’ levy rise, which is not even committed to Medicare. The education system no longer produces tradesmen to do the job and private education rip offs abound from dodgy day cares to non-Gonski funding to schools to post-TAFE colleges selling dubious certificates to phantom colleges ripping off visa-seeking migrant students.
The public service is being ‘hollowed out’. It no longer retains centres of expertise as it can always buy ‘consultants’ who carry briefcases and impressive CVs and have no interest except the public good. It closes offices, hires short term workers, relies on PR driven websites and replaces people with knowledge by ‘Services NSW’ which has someone who might know which department might do what you might want.
Our existing political system seems unable to govern in our interest. The interest of the political parties no longer coincide with the public interest. Our governments’ decisions have been bought like everything else. I do not think that money can be held at bay by electoral funding law reform. When we fought the tobacco industry, it sponsored sport and culture to get political allies. When that was banned, it sponsored ethnic groups, rescue boats and helicopters, any worthy cause that could lobby for it, and that was without gifts in kind, dodgy ‘foundations’ or other less visible influence-buying.
The only answer that I can think of is Swiss-style democracy where major decisions are taken by referenda of the people, and Parliaments merely implement decisions that the people have made. Any other suggestions?
03/03/2017
Social media is increasingly important as it replaces mainstream media and mixes personal interaction with news and information. It is dollar driven but also personal, so that we identify ourselves and our values. Those who communicate with us individually do so with personal or mutual interest, but those who do mass communication do so for financial or political interest. Since those at the big end who harvest the data are able to match the personal with the financial and political, it gives them immense power. At the little end getting someone to click on something can give you a lot of money that you would not have had, so a gimmick or a headline that makes people click on something is a trick to be striven for, without necessarily thinking through the consequences.
To illustrate this important thesis, I offer this article from The Saturday Paper, which is its later part suggests that fake news was merely headlines that would get clicks to make money and that Trump was used as he would make people click. The fact that this favoured his campaign was an incidental to the primary object of the fake news creators, who merely wanted the royalties from making people click. The idea that the tiny fractions of a cent per click on a website can create a President of the USA shows how far our decisions and lives are at the mercy of the short-term profit motive.
The power of collected data is that it allows the correlation of people interests, values and core values. Knowing what people believe, what is important to them and having access to them either through friends, honest communications or disguised communication gives the ability to change large sections of the populations values and actions, which gives a whole new meaning to the concept of ‘Manufacturing Consent’. This is very significant for the nature and use of power.
Marx said that power was control of the means of production. In nominal democracies power will become control of the means of information. This is frightening stuff. It was in the Guardian. Read on if you missed it.
www.theguardian.com/politics/2017/feb/26/robert-mercer-breitbart-war-on-media-steve-bannon-donald-trump-nigel-farage
Note also
www.theguardian.com/technology/2017/may/07/the-great-british-brexit-robbery-hijacked-democracy?CMP=share_btn_fb
27/12/2016
Today I reconnected with Dr Ben Ewald from the Hunter, who has been working with Doctors for the Environment. He has been lobbying for a Federal EPA and wrote a submission on the load-based licensing system, which is another name for polluters paying a levy per tonne of pollutant that they produce. There is some charge for each type of pollutant, and the charge can also be loaded for how close the pollutant is to population centres, as this relates to its health impacts. NSW has had such a scheme for years, which is fact the best developed in Australia, but NSW keeps the rate of this tax very low otherwise NSW would merely end up importing electricity from other states that pollute more but had no such tax. Hence the need for a national system. The current NSW fee is only 0.82% of the sale price per megawatt.
Other facts were that there is 1.1 million tonnes a year of Sulphur dioxide produced in Australia, 51% from coal-fired power stations. They also produce 380,000 tonnes of Nitrous oxides, 52% of all produced annually in Australia. Coal-fired power stations produce 8,900 tonnes of PM2.5, which is however only 29% of the national output of PM2.5, which is 31,000 tonnes. PM2.5 is particles of 2.5 microns in diameter, which are the smallest ones measured. There used to be a lot of emphasis on how much pollution in the air by how much weight of pollutant there was per cubic metre of air. Then researchers realised that big particles get caught in the nose, whereas small particles continue down into the lungs and have bigger health effects. So the absolute weight of particles is not as important as the number of smaller particles. Hence the new interest in PM2.5!
It also turns out that while the coal-fired power stations are the ones with the load-based licences, the open cut mines produce the most carbon particle pollution but are exempt from fees! That is a political decision of course. Doctors for the Environment need to be supported as they beaver away producing the submissions and organising the facts that the governments need to be told and that the activists need to amplify! Here is the submission:
26/11/2016
26 November 2016 Power, Injury and Awards. I work in medicine, treating mostly third party motor vehicle injuries and workers compensation injuries. There are much fewer of the latter because there are less employees. Many people working as couriers are ‘self employed’ contractors. One man had to pay $75,000 for the right to deliver parcels […]
09/11/2016
Here is my theory. Basically democracy in English speaking countries has been taken over by private entities. There are only two entities who can win power in the UK, USA and Australia. They are called political parties. They are not in the constitution, but because they vote as a bloc, they control the parliament. Because they are private entities they do what their donors want. Few citizens want privatisation, but the donors to the parties do- so we get privatisation. Few want to go to war, but for some reason the parties do, so we go to war. We want universal health cover- Medicare, but it gets rolled back and we have to buy private health insurance, which suits that lobby. Unemployment is rising and the government fiddles the figures and no longer takes responsibility for the problem, it just talks about ‘the market’. What the people think or want does not actually matter. The parties continually put their interests and power ahead of what the people want. The rich are getting richer, the poor are getting poorer and the political parties do not seem to care. They get donations from the rich, and run campaigns to convince the poor to vote for them.
Faced with this situation and two political parties, people are accustomed to voting for the lesser of two evils, or making a protest vote, which is what they did. Trump was anti ‘the system’, so although he was deeply flawed personally that was enough. The Democrat Party machine had got rid of Sanders, the leftist challenger to the status quo, so it became status quo Clinton v. Non status quo Trump. Then the polls got it totally wrong. How come? Part of the same thing- the whole polling establishment obviously had a large segment of the population missing from their sample, but did not know it- like the government really. So if some people did not vote for Clinton because they were disgusted and thought it would not matter, they were wrong.
But if the level of disgust in the process of government is enough to turn a US Presidential election, one must also wonder about the effect of the media. For years, news has been replaced by infotainment. What is important is replaced by what is titillating or exciting. News is trivial, what is important is often not covered, particularly things like falling middle class jobs and stagnating wages. The media is the message. If you are not in the media, the message is that you do not matter. But also note the rise of ignorance. Quiz shows used to ask historic or scientific facts. Now it is TV trivia. And ‘shock jocks’ on commercial media are there to shock and to push products. They do not have to be consistent or informed- just entertaining enough to rate and bring in advertising dollars. So the non-expert, pontificating and criticising overcomes the expert discussing sensibly- how many of those are on TV? The shock jock has become more important than the politician. So why are we surprised when it now happens in real life? The shock jock beat the politician. And the pollsters got it wrong again- just like in Brexit.
What will happen with Trump in charge? He will destroy Obamacare, the relatively minor improvements made towards a universal health system, appoint Conservative Supreme Court judges and officials in public policy such as Climate Change, and boost gun ownership. More significant changes to corporate power will take the approval of Congress and the House, now both Republican-controlled. Obama was elected on the slogan, ’Change is possible’. Obstruction by the Republicans ensured it was not. Now Trump will try, but the same obstructers now have even more power and are not about to let one of their own damage their interests. So Trump is unlikely to be a force for good unless he has unexpected foreign policy triumphs.
So what is the long-term solution to government ruling for the rich by buying political parties? Democracy has to be taken back to the people. The Parliament is controlled by parties and they are private entities and so can be bought by other private interests. This has ever been the case in systems that evolved in Westminster. It is Anglo-Saxon arrogance that makes us think that our democracy is best. Quite simply, it isn’t. Our political power structures, like our corporate structures concentrate power at the top. Swiss democracy involves power being moved down as low as possible with politicians merely enacting what public referenda decide, and with no opportunity for individual politicians to get long-term power structures assembled for themselves. It is time we looked at these models and worked for constitutional change based on a real change of philosophies, priorities and power.
09/11/2016
9 November 2016 Here is my theory. Basically democracy in English speaking countries has been taken over by private entities. There are only two entities who can win power in the UK, USA and Australia. They are called political parties. They are not in the constitution, but because they vote as a bloc, they control […]
11/09/2016
CTP, Compulsory Third Party insurance (Green Slips) is an area where I work. In theory, if you are injured in an accident that is not your fault, all your treatment is currently paid for by your insurer. The law says that they must pay for ‘reasonable and necessary’ treatment, which I assume to mean the treatment that would happen in good routine medical practice. Wrong.
The insurers have 3 months to decide if they are liable for the accident. If they decide they are not they will not pay. If they decide that they will pay, all treatment decisions have to be referred to them as to whether they will pay or not, and sometimes, despite MRI scans, severe symptoms and a neurosurgeon saying that their life is at risk, they will not pay. I have a number of patients who have waited over a year in agony for treatments that are both reasonable and necessary but the insurers will not pay for. They say that the patients can get it themselves if they like (obviously if they can afford it), of they can get it on Medicare (if they have Medicare and if they can find a surgeon who will operate on Medicare for a third of the money that should be paid by the insurer. Such surgeons cannot be found).
The protocol for disputes vary slightly between insurers. For example, the NRMA protocol is that you can firstly approach the claims clerk who rejected it and ask him/her to change their mind. Secondly you can appeal to their team leader. Thirdly you can appeal to the NRMA Senior Claims Manager. Fourthly you can appeal to the government appointed Medical Assessment Service (MAS), which guarantees to assess the disputed issue and rule within 3 months! Or the treating doctor can try to find a Medicare surgeon, send them to a public hospital, or write yet another prescription for pain killers. (Mostly the insurers pay for pain killers, though they do argue over some other drugs). Many GPs have simply given up treating CTP patients.
All these delays, frequently running into months can be compared to the doctors and nurses in Emergency Departments of public hospitals who have to write long explanations for the Health Minister if patients wait more than 4 hours in the Emergency Departments. So if you think private medicine is better than public- think again. We are going the way of the US. Insurers control it all.
Patients are assesses by an iniquitous system devised by American Insurance companies in cooperation, (inexplicably enough) with the American Medical Association. This has resulted in a tome, the ‘AMA Guidelines for the Assessment of Permanent Impairment’ which supposedly gives a percentage of impairment of your body, so that injured people can get compensation based on the percentage impairment that they have. Doctors can do a course in how to use this guidebook and then do lucrative medicals based on it. The reason the book was produced was to lessen litigation on how injured someone was, which would save legal costs. As pain cannot be measured, this was left out, which is just the first reason why the book is a farce. Since pain is the main thing that stops people working, to talk of impairment without considering pain is almost like having a swimming race without water- just not quite. Secondly despite the tome’s carefully crafted descriptions, doctors assessment using the guidelines vary widely. Thirdly, it is very hard to get over 10% impairment, which is the amount Mr Baird’s reforms intend to define as more than a ‘minor injury’ so there will be many people with only a few percent impairment, and thus minimal compensation, who will be unemployed and unemployable. Fourthly, the guides only talk of ‘impairment’. Any one who works in disability knows that there is quite a difference between an impairment and a disability. For example if someone is very shortsighted they are impaired, but if they have good prescription glasses they may not be disabled by that impairment. People who work with their brains are similarly less disabled than those who need their physical strength, but have the same impairment. So physical workers are again disadvantaged.
The new scheme will cut out lawyers and advocacy, and will give a statutory small amount to ‘minor’ injuries. The insurers will dump long term patients on the welfare system and continue to get a lot of money for doing not much that is useful.
I would finish by saying that I think the whole system is appalling and that the way to solve the health system problem is to raise the Medicare rebate from 48% of the AMA fee to 85%, where it was when it started, and there would be no trouble getting doctors to treat the patients who needed it. There also needs to be a single insurer, so that disputes between insurers will not delay treatment, which they frequently do, and everyone should be covered, even ‘at fault’ drivers, who still need treating despite their error.
For the present six insurers, all are bad, but they are not all as bad as each other. There are no published figures to compare them rationally, but based on personal experience, I have just changed my insurance from NRMA to GIO. The TV ad about feeling ‘confident’ about your insurer is a bad joke.
Wish me luck, as I wish you.
Here is an SMH article by Anna Patty 12/9/16 which raises the issues in a somewhat understated way.
www.smh.com.au/business/workplace/green-slip-reforms-will-leave-most-motorists-to-fend-for-themselves-20160905-gr8zca.html