Doctor and activist


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Category: Health

Mutual Obligation and ‘Noblesse Oblige’

18 March 2021

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

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

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

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

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

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

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

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

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

Watch this video re the privatised employment agencies.

https://nsfuw.com/?secure_token=8fb90d8862532ccff17c55370720566372b28b851af78200f9c4a13b9171c28e&t=GZ1ZJT09R&utm_campaign=Expose_predatory_job_agencies&utm_content=30518&utm_medium=email&utm_source=blast
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iCare Doesn’t Know and Doesn’t Pay Underpaid workers

7 March 2121

The incompetence of Perottet’s iCare never ceases to amaze.

It underpaid injured workers but was not sure how many. It was initially 240,000. Then it changed its to estimate to 52,000 people underpaid up to $80 million. Then possibly as little as $5 million. In March it is 23,000 and $20 million. They don’t actually know. After 18 months 25 have actually been compensated!!!
This is all treated as some of ‘management error’ as if this makes it OK. These are a lot of abstract words, but few concrete ones. The idea of abstract words is that the concepts can be discussed better. But mostly management words are so general as to be meaningless, and principally serve to make everything non-specific and also euphemistic. No one says, ‘They did not know or care and their incompetence led to immense suffering for the families who were underpaid’. It becomes, ’There was a lack of management understanding and focus and some workers may have been paid less than their entitlement’.
Naturally no one will be punished.
All I know is that even the routine service takes about 3 weeks to get anything done. I had a patient doubly incontinent after a spinal injury. It takes up to 10 working days to get a claim approved, then up to 10 working days for them to approve an MRI and a specialist consultation. This is normal. When they delay things it is worse, and sometimes they refuse to pay at all.
www.smh.com.au/national/nsw/scathing-icare-review-finds-a-need-for-cultural-change-20210301-p576tq.html

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Scathing PWC Report Finds Perottet’s iCare Incompetent

6 March 2021

A 100 Page report by consulting from international PWC (Price Waterhouse Coopers ) found weakness in performance and governance, and the Board did not hold management to account. 

We might also consider that the Minister, Dominic Perottet did not hold the Board accountable, and appears to show no interest at all in the injured people for whom the whole scheme supposedly exists. We might note that no doctors or patients appear to have been interviewed either- Hey, it’s all about money you know!  One could ask why PWC did a report when Justice McDougall was simultaneously doing one that it coming out in April?  Perhaps he is a lawyer and does not know enough about money.

The bottom line is that it was run from the top by people who only knew about money with little input about its proper function from the people at the coal face, who presumably should have some knowledge of the people that they are supposedly helping.  (I say that with reservation, as the case managers that I deal with have high turnover, little insight and seem to assume that a large percentage of their cases are fraudulent, the doctors are hell-bent on inventing pathologies to over-treat and they have to follow elaborate protocols designed to ensure that no one could under any circumstances get one cent more than was absolutely necessary).

So we digest the Management-speak of this report and await the McDougall report which had terms of reference that allowed little input from patients or doctors, held no hearings and seemed to exist principally to take the heat off the Minister from last August until its April release.

It seems that there has been a generic concept since the 1980s that managers know best, that other degrees and knowledge from lesser beings or lesser ranks and incomes are not of value or to be listened to.  It has come unstuck in so many situations that its time that some little boy (or girl) points out that ‘The Emperors have no Clothes’.  Then we can go back to an older time, where people had appropriate training, worked their way up, knew their jobs, were promoted on merit and had small salary increments reflecting their incremental status rise.  But I suppose that this would rely on people having permanent jobs and depower the whole new managerial class and their symbiotic consultants and reduce the workplace ‘flexibility’ that allows the obscene salaries at the top and insecurity at the bottom. 

If Anglo society does not want to fall to more realistic societies in Germany and Asia, there needs to be a large rethink of the Harvard 1980s management nonsense that is the foundation of these sort of debacles.

www.smh.com.au/national/nsw/scathing-icare-review-finds-a-need-for-cultural-change-20210301-p576tq.html

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JobKeeper becomes an Unaudited Subsidy to Big Business

6 March 2021

It seems that while JobKeeeper did help employees, some businesses did not actually need it, but got it anyway.  Now it is ‘moral issue’ that they give it back- that is to say it is voluntary.  If they have already taken it as executive bonuses or shareholder dividends it is probably not refundable.

The welfare recipients who had spent money and were accused retrospectively of Robodebt could not repay it either, but were hounded till the end.  All that will happen to the big end of town is a few days of newspaper articles.   

It is surely a reasonable principle that if taxpayers’ money is given away there should be monitoring of where it goes. If it was too hard to set up a monitoring system quickly, the obvious solution would be to make a regulation that it had to be used for purpose and would be checked and there would be prosecutions if it were misused. This would have allowed follow up, a few prosecutions and majority compliance.  This government seems incapable of any sensible management of anything, unless you think that deliberately handing money to mates is an unwritten policy.

Now even small businesses are annoyed.

www.smh.com.au/politics/federal/pretty-close-to-theft-small-business-slams-big-corporate-jobkeeper-profits-20210304-p577sn.html

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Privatisation of Quarantine = Government Collecting Money for Corporations- Permanently??

21 February 2021

There are two quarantine stories extant, one short-term, one long-term:

The Sun Herald front page story is ‘State Debt Collectors eye hotel millions’.  It is about how 5264 invoices covering 7214 travellers who stayed at quarantine hotels have not paid and thus have to be chased for the money.  The fact that they had to stay at these very expensive hotels for 2 weeks to be allowed to come home seems irrelevant. The fact that they may have had to stay in hotels for 9 months overseas in lockdown situations, had to come home  on very expensive flights  and may have no money and no job is also not mentioned.  What might have been thought of as repatriating citizens caught in a situation that was not of their making is now a routine debt like a speeding fine, to be chased by the NSW government’s privately contracted debt collectors.

Meanwhile down in Victoria in today’s Age there is talk of building a quarantine hotel at Avalon Airport.  Avalon airport was ex-RAAF and is about 3 hours from Melbourne (as I discovered to my cost when taking a Jetstar fight to Melbourne without looking where it landed). It is now owned by Linfox Transport group, and the Wagner Corporation of Townsville was keen to build the quarantine facility.  When asked by an interviewer what accommodation would cost, Mr Wagner replied that this was ‘commercial in confidence’.  There was none of this nonsense about giving arriving travellers a ‘fair go’; presumably such assurances are not necessary to get the contracts these days.

The colonial-era Manly Quarantine Station, which was saved from developers some years ago and remains in the dangerous situation of being  a historic site in NSW used to have 3 levels of accommodation, for the rich, middle class and poor. At least the financial reality was recognised then.

Presumably backpackers who needed to come home would be happy to stay in backpacker accommodation, whereas some business folk really cannot manage less than the Ritz.  But the government ought to make provision for Australians who want to come home and returning travellers needing to be quarantined should have the right to return without having to pay whatever a privatised accommodation facility chooses to charge them, without the government’s contribution being to unleash the debt collectors.

www.smh.com.au/national/nsw/it-s-not-optional-debt-collectors-sent-in-for-overdue-quarantine-hotel-bills-20210219-p5747y.html

www.theage.com.au/business/companies/bold-brash-and-benevolent-wagners-wheels-turn-to-quarantine-facility-20210219-p5744b.html

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Health Effects of Coal

14 February 2021

Here is Dr Peter Sainsbury, Prof of Public Health. writing about the health effects of coal. Many of the deaths related to the polluting effects are not in Australia, which is not a very reason for us not to be concerned about it.

Some years ago, as we tried to stop the subsidy to Tobacco Growers in Australia, the number of deaths of tobacco-caused disease was compared to the number of jobs in the tobacco industry, which was orders of magnitude lower.

Sainsbury says it will be about 6 deaths per year per job in the coal industry, which is yet another good reason to transfer to renewable energy.

The practice of looking at the number of deaths caused versus the number of jobs created seems a sound basis for looking at the cost benefit of industries. The ‘defence’ industry needs to be looked at in a similar way.

The other interesting fact in this article is that he estimates that Electric Vehicles will be the same price as petrol ones in about 3 years because of the falling price of batteries. Presumably the Morrison government cannot retard progress forever.

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COVID Problems Caused by Lack of Respect for Knowledge

7 February 2021

Prof Raina McIntyre argues that the COVID19 problems in the developed world, particularly the Anglo world are the result of an understanding of and a lack of respect for public health.  She charts this as within the medical profession, which has its own hierarchies, but also in the political arena.  The overwhelming influence of the corporate sector and the profit motive, and the managerial approach which assumes that if  you are not an expert, you can quickly find one, bone up and take over has been found sadly wanting.  For a manager or politician, selecting an expert is not as easy as it sounds as there are many people who want to tart up their CVs and market themselves with dubious claims to expertise.

This has resulted in a very suboptimal preparation for and response to the pandemic. The failure in the managerial decision-making process has been laid bare in the COVID situation, but this is not an isolated example.  The lack of respect for expertise, the replacement of knowledge with marketing spin, and public good with corporate profits will lead to more bad decisions, which often take a crisis to become evident.  It happened in the bushfires, and is happening with climate change. Examples in foreign policy, education, health and defence all come to mind.

Here is Raina’s paper about COVID19

https://iser.med.unsw.edu.au/blog/hijacking-public-health-and-price-paid-during-covid-19-pandemic

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Police Leaving the Police On Medical Grounds Triples- Why?

7 February 2021

We might ask why NSW Police leaving the force on medical grounds has increased from 150 a year in 2014-15 to 420 in 2019-20, almost triple.

There is talk of a culture of bullying.

We might ask what they are being asked to do. Public perception seems to have changed when the changed their name from ‘Police Service’ to ‘Police Force’. The perception that they are now revenue raising, and that their cameras are so that they cannot use their discretion as they themselves are being watched may have contributed to this.

My own view is that the ever-more invasive laws that they are expected to enforce tends to have this result as they are more often thrown into conflict with ordinary citizens who they thought that they were there to help.

www.smh.com.au/national/nsw/fish-swimming-amongst-sharks-why-so-many-police-are-quitting-the-force-20210202-p56yp6.html

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Are Google Algorithms Reinforcing Anti-Science positions? 3 Feb. 2021

As the anti-science movement seems to gain strength and undermines the campaign for COVID vaccination, there has been increased interest in the origin, strength and tactics of this.

It is blamed on the Russians, who presumably are trying to weaken and divide the West, and on civil libertarians, who want to politicise medical common sense.  But when it helped by people like Trump in the White House and Kelly in Australia the conspiracy theories are put into perspective, as the anti-science views are given legitimacy.

But in the fuss about Google withdrawing from Australia, or not covering Australian politics, I wondered what effect this might have and tried a different search engine, duckduckgo.  The difference is that google gives me a personalised feed, but duckduckgo gives everyone the same information for the same key words. 

Search engines at a basic level give a ‘top pops’ of popularity of a topic in that those with the greatest number of clicks go to the top.  This may be fine if you are looking for a movie review, but if you want older material it will be a long way down. Scientific articles are a lot further down than mainstream ones, and the algorithm is influenced by the viewer’s previous viewing habits.  If a person has viewed a lot of conspiracy articles, it is presumably then likely that these are more likely to come up again and reinforce the existing views of the viewer.    If the feed is continually biased to a point of view, the viewer is likely to come into contact with more of this view and people who share t, so that they are eventually in a bubble or subculture of people with this belief, and are unaware that their reality has been changed. 

As an example my son went to school with a boy in NZ whose father controlled feral pests for a living, which meant shooting rabbits, ferrets, deer, pigs, cats and possums which are predators on various farms in NZ.  He kept in touch with his friend and they played video games online.  But his friend went shooting quite a lot with his father, joined a gun club and started to receive the literature of this subculture.  His previously non-political, mainstream views are now hugely influenced by the American gun lobby and rabidly right wing.  This is quite unusual in rural NZ.  My son commented, ‘In the end, you think what you get in your feed’.

The algorithms exist to make you happy and to keep you clicking in order to get you to buy things.  But the result might be quite different- a creation of a bubble environment where everyone’s opinion tends to be magnified, sometimes going in a bad direction.

How this can be controlled is a question- if we all got the same feeds, would the sensible people make sensible articles come up first?  Presumably; if most people were well educated.  We had better go there also.  Which Big Brother will tell google how to do its algorithms?

(The longer version of this attached article is available via a link at its end).

https://www.huffingtonpost.com.au/entry/peter-hotez-anti-science-movement-killing-hundreds-of-thousands_n_6014b39ac5b622df90f382ee?ri18n=true&fbclid=IwAR19_qqWuNe9t8ySSTdNU5OjL6jKkxPCT3cDbAP0EhAKXoXrLPod_xVfdKM

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