Doctor and activist


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Category: Occupational Health

Government protects Bonuses of iCare Executives while workers are dudded.

20 May 2022

Some things make me unspeakably angry.

In the SMH online today the government giving bonuses to executives who presided over iCare cheating injured people out of their payments and treatments.

In my real job, I treat injured workers and motor vehicle accidents. Many wait more than a year for surgery- my longest was 9 years. They are subjected to Independent Medical Examinations that find any other reason than their accident for the cause of their pain. Age, previous injury and arthritis are the commonest ones.  It is stated that they are fit for work, when they are obviously not, or that they can get another job when they obviously have no physical or mental capacity to do another job, let alone compete for one. 

The ongoing inefficiency of the computer algorithms making decisions without even anyone being responsible was the brainchild of John Nagle, whose other bright idea was to change his KPI (Key Performance Indicator) from getting people back to work, to having them declared fit to be back to work.  Nagle resigned after a bad day at a Parliamentary inquiry. All this happened while iCare was under Treasurer Dominic Perrottet. 

A friend of mine injured his back lifting on a Friday. He called his GP and visited him on Saturday. He had an MRI scan on Monday which showed a bad disc injury, saw the neurosurgeon on Thursday, had a discectomy on Saturday and went home on Monday. All fixed in 8 days. That is what should happen. It never happens in the WC or CTP system.

The Workers Comp system takes 14 days to accept liability, then has to ‘decide’ if the treatment is appropriate, so weeks go by, and if they dispute it, years. People wait 3 months for the insurer’s medical examination, 6 weeks for the result of it, another couple of months for their specialist examination and a few months for the government medical to settle the dispute.  And they blame the injured people for the worse results out of the system, and give bonuses to those who managed to reduce the costs.  Given the huge administrative machinery, the clerk, investigators, extra medical examiners, lawyers, dispute resolvers and the rest, all the savings come from not treating people.  And those responsible get bonuses, and the government, ever keen not to upset the private sector ring-ins makes sure that they are amply rewarded for this appalling situation.  Perrottet, the most recent architect of iCare, had a 2nd inquiry by McDougall to kick the can down the road, then rose to be premier before his report was out. 

Here is the SMH article:

Government votes to protect bonuses for icare executives

By Lucy Cormack

May 20, 2022 — 5.00am

The Perrottet government has protected bonus payments for icare executives, rejecting a bid to ban the practice after revelations millions of dollars in bonuses were handed out while injured workers were underpaid.

The attempt to strip bonuses from executives at the state insurer was contained in Opposition amendments blocked in the lower house this week during a vote to amend the state insurance and care legislation.

Icare has been the subject of intense scrutiny since an investigation by the Herald and ABC TV’s Four Corners in 2020 revealed the underpayment of workers while senior executives claimed almost $4 million in salaries and bonuses.

The insurer, which provides workers’ compensation insurance to 3.6 million public and private sector employees in NSW, has since been forced to repay $38 million to 53,000 injured workers.

The scandal prompted the government to amend legislation governing icare, following a review by former judge Robert McDougall, QC.

More than 200 icare employees are entitled to bonuses, including chief executive officer Richard Harding, who is entitled to an incentive of $411,000.

Opposition treasury spokesman Daniel Mookhey said there was little justification for bonuses while the insurer continued to record billions of dollars in underwriting losses.

“Employers are staring down the barrel of a decade of rising premiums, yet the government is protecting bonuses for top executives at Australia’s most disaster-prone insurer,” Mookhey said.

“We intend to stand up for employers and injured workers. We will fight against lavish bonuses for icare’s top executives in the Legislative Council next week.”

During debate on Wednesday, Minister for the State Insurance Regulatory Authority Victor Dominello said the McDougall Review had not found executive bonuses at icare were excessive.

He said McDougall noted the benefit of allowing icare to set competitive salaries to “attract appropriate talent”

The Herald last year revealed icare hired 18 new executives with potential annual bonuses collectively worth more than $1.2 million, while employee operating costs have increased from $162 million to more than $200 million since 2020.

However, an icare spokesman previously told the Herald no executive bonuses have been paid in the past two years.

Unions NSW boss Mark Morey wrote to NSW MPs last week calling for reforms to address “repeated governance, financial and operational crises”, including ending executive bonuses.

Other proposed reforms included enforcing the same procurement laws that govern the NSW public sector, from which icare is exempt, and appointing an injured worker to the board.

Morey on Thursday said the government had missed an opportunity to “clean up” the state insurer.

“How can the premier justify continued bonuses for highly paid executives when sick and injured workers have been dudded and small businesses are paying increased premiums?” he said.

Other changes sought by the government included additional powers for the State Insurance Regulatory Authority and expanded access to commutation, which allows injured workers to negotiate lump sum payments and exit the system, rather than remain on weekly payments.

However, the government agreed to withdraw its proposal to allow changes to commutations via regulation and reconsider them in future legislation.

Opposition spokeswoman for industrial relations, work, health and safety Sophie Cotsis said she was pleased the government had agreed to consult further on lump sum payments, arguing that regulation should not be used to expand the system.

The State Insurance and Care Legislation Amendment Bill 2022 will now move to the upper house, where the opposition will make another attempt to ban bonuses.

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Bullshit Jobs

8 April 2022


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

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

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

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

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

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

Here is Wikipedia summary of the book:

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

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

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

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

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

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

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Motivation and Money

25 September 2021

Some years ago, I won a Public Service Fellowship to study workplace absence and had what the Americans call a boondoggle, with a world trip to look at why people attend or do not attend work.

One outcome from that was that I stopped using the word ‘Absenteeism’ as that is a valued judgement suggesting a worker disease, and used the term ‘workplace absence’ which, as the progressive journals at the time insisted meant that an employee considered that they had a better reason not to be at work.

Unsurprisingly people who had more interesting work or control over their work were less likely to be absent, while those in boring production lines were more likely.  The US car industry had absence rates of around 10% and handled this by simply rostering on excess people in the assumption that people were not going to turn up.  A union OHS academic there said that the rates of what we called RSI were very high, but I did not get to examine workers and naturally no figures were available.  

People who needed to be away from work also were more often absent, particularly women with families whose incomes were lower than their partners.  Later I looked at age groups and health as these were measureable and confirmed the general conclusion that health did not correlate with absence.  People who had a chronic illness were less likely to take sick days as they might need them later, whereas young healthy males wanted to go surfing. 

The Swedish car industry let workers have quite a lot of autonomy, but this had led to the workers trying to finish early and giving themselves RSI, but the Swedes were not keen to talk about this, as they had been studied by too many itinerants like me, (and one suspected that they did not like what we had found).

The Japanese worked very long hours, and had token payments systems which kept a peer pressure to gain this respect, but the last  part of their long working hours tended to be not very productive, because the peer pressure was merely not to be the first to leave.  Again, this insight came from US academics; not the Japanese.

One of sillier things that I noted in some management training that I had was that some still seem to think that the only thing that motivates people is money.  This seemed so simplistic to me as to almost absurd, but it was still taught.

So I was interested to see an article today by Malcolm Knox  in the SMH about the motivation of the Melbourne Storm Rugby League players, who are favoured to beat Penrith in the second preliminary final this afternoon.  Some of their players are paid much less than they would be if they changed clubs, but they stay there because of their respect for the coach, and for the fact that the team wins.  Young fullback Ryan Papenhausen is quoted as saying that he stays while Bellamy is coach because he thinks he will improve most while coached by this man.  So despite salary caps, which are designed to even up the quality of players between clubs, Melbourne have more than their share of stars.

I have not been a huge fan of Rugby League over the years as it seemed to merely have people bump into each other and lacked the subtlety  and variety of Rugby Union, particularly the innovative movements of the All Blacks.  But their variety and flair is improving, particularly with the work of Nathan Cleary at Penrith, which is now being watched and copied to the level that other teams have been beating them.

We can watch Melbourne Storm v. Penrith from 4pm, but I will also be thinking that if Melbourne wins, it will say something about motivation and money.

www.theage.com.au/sport/nrl/splitting-heirs-papenhuyzen-storm-s-regeneration-proves-the-cap-doesn-t-fit-anymore-20210924-p58ugx.html

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iCare= Hopeless in Two Reports but the Bad Joke Continues

30 April 2021

Two reports on iCare have come out on the same day- how convenient, one lot of publicity rather than two.The report of the Parliamentary Committee was one report, the other was a report by Robert McDougall, a retired Supreme Court judge.The political report looked at the disgraceful evidence given by John Nagle which showed almost no care for the injured workers and an appalling attitude of entitlement in him and his crony staff. iCare had not even known what workers’ Pre-Injury Average Weekly Earnings (PIAWE) were, and had not tried very hard to find out so that they could underpay them and minimise their costs. They relied on computer algorithms rather than staff to manage the claims, only getting staff on the case if there were problems, which there usually were, as the poor patients were having their treatments delayed or denied.
The McDougall report had its terms of reference set by Treasury, who were also the department being investigated, and they also staffed the inquiry. The Treasurer, Dominic Perrottet did not agree to be interviewed by McDougall and got away with this. Is this some sort of bad joke? The McDougall report found incompetence etc, but no actual corruption that anyone could be charged with. As such, the McDougall report was a political success. It took the heat off the Treasurer from November to now, and will result in a bit of publicity, no serious recriminations and the usual promises of future action. John Robertson, an old union hack is the new CEO, so Labor will not criticise iCare now.
My poor patients will be mucked around, be underpaid and have their treatment denied as usual. And Treasurer Perrottet will sail on hoping to be Premier as Gladys falls. What a joke!


www.abc.net.au/news/2021-04-30/damning-reports-released-over-nsw-icare/100107076?fbclid=IwAR34I_blTADSxa2OoWxrzOpvgNPZ3KUFmhQmpSFZHd4LSOIVdof0nx8yMGs

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Labour Hire Companies facilitate Wage Scams

5 April 2021

When I was in Parliament the then NSW Labor Government had an inquiry into WorkChoices, which was the Howard Federal government’s preferred industrial relations model. It was, as the Liberals said, an political inquiry designed to criticise what Howard was doing. (Historians will recall that it cost the Howard government s lot of votes).

But both Unions and Employers came and lobbied me, as did Labour Hire business owners. The Labour Hire companies said that they could get a better deal for the employees as they were negotiating on their behalf with employers and if they had special skills the employers would have to pay for these. I asked them how much commission they took on this as obviously employers would have to pay their commission as well as the subcontractor’s payment. They were very reluctant to be specific on this point as it was ‘variable’. But it did seem to me that the chief objective was to make the worker a private subcontractor rather than an employee and thus remove award pay rates, holidays, sick leave, workers compensation, and bargaining power. The Labor Hire company was often just a commission agent, though some employed the workers.

It seems that this model of getting rid of direct employees has evolved and is now standard in many industries. I have seen a woman accidentally stab herself in the forearm while boning chickens at 3.30 am on a 12 hour shift, a man shoot himself in the heart with a nail gun trying to assemble flat pack kitchens alone and RSI in a hotel worker so advanced that it has made no recovery in 3 years, after being expected to clean high-end hotel rooms, including making the bed, vacuuming and cleaning the bathroom in 12 minutes each.

‘Subcontractors’ may have no awards, no unions, no OHS and no redress when people are ripped off. The lumbering ‘Fair Work Commission’, out of sight and out of touch seems to make very little difference to a Darwinian model.

Let us see if criminalising wage theft makes any difference. There are a lot of laws on the books that are never enforced.

https://l.facebook.com/l.php?u=http%3A%2F%2Fwww.smh.com.au%2Fbusiness%2Fworkplace%2Faustralia-s-shocking-wage-theft-scandals-keep-coming-by-the-truckload-20210312-p57a5p.html%3Ffbclid%3DIwAR3FoKWzuLj-nv9W5moUs7K-HmlfV8msxTXhOicq62KM83zMerzWwcFiJYM&h=AT3RrEZXGjEyZeQ7rNBoGGgl9Flo0_zzfDuqRAnUxguMlUcU-J9oiuQGDpT01vJnqPsdtFErgLw0g92bkmtQt_TQ-vPzVqPsWvYaVFbIYosdg1YBYAm5Fke4e4-OdaDB8JwYckGgwuhNR5mltMZO&tn=-UK-R&c[0]=AT2ipxj2y11laB8hdM-suLNA2ij5tamnMBYbjAGX5r25jhtlSzzvd-Dn6kj1lQ88fBiyw1dyFFnNXi8tEuTfOVY_74RgrorvDvqc2EuyAIWBJMbsZjzjqyCneyp7HOlhnr8r_bd9dZtlDER2pMrWsThzMw
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Drug Testing and Strip Searching 7/11/19

7 November 2019

I have some experience in this area, though I would not seek to overstate it.

In 1985 I won a public service fellowship to look at workplace absence and I looked at the evidence of whether drug testing in the workplace worked. The main place it was suggested was at pre-employment medicals. The idea was that if you tested them and they were OK, they could have the job. It was a pretty silly idea as only a really serious addict would come to job medical interview with drugs on board so the pick up rate was low, the costs high, and the impression on the workers quite negative.

Later in my OHS job a worker was sent in for a medical as he was said to be using hard drugs in the portable toilet (thunderbox). He was taunting and arrogant, saying that I could not prove anything, and could not do anything as he would not give permission for the test. He was right of course, but he soon proved his accusers right as well by falling out the door of the thunderbox with a needle stuck in his arm.

When I worked in private OHS, the NSW State government saved money by sending people on parole to be drug urine tested on Medicare by local GPs. I was stuck with it in our practice which was one of the few that still agreed to do the testing. A man came in, angry and abusive, demanding immediate service, which he was granted to stop him terrorising the waiting room. He brought in a jar of very cold urine for testing. I said that I wanted a fresh specimen, gave him a jar and pointed to the toilet, ten paces away. He left to ‘get a new specimen’ and came back some time later. I said that I wanted to see him pass it, so he pulled his undies down saying, ‘There it is, are you happy now?’ No I wasn’t, as he had another small vial of urine in his hand as he held his undies. ‘You are a hard bastard’, he said as he eventually passed the urine, which unsurprisingly showed he was still using narcotics. The Parole people were pleased. They said, ‘We knew he was using but could not get a GP to get us a specimen’. I was not surprised that GPs were reluctant. At $15.20 for a Medicare visit that involved a terrified waiting room, half an hour of time, a threat to have your head punched in and the disruption of a whole afternoon for a whole medial practice, I told them that we were not going to continue testing either. Presumably he went back to gaol, and one might wonder how much good that did.

My next encounter was a female friend who had been very traumatised by a previous serious rape attempt that she had fought off. She was going through Central Station on her way to work, when a sniffer dog made the Police insist on searching her bag and ‘patting her down’. She had an empty plastic bag in her handbag that she had had a small amount of marijuana in some weeks before. But she was very traumatised by the experience because of the memories that were stirred and by the idea that she could not even walk around without people assuming that they had the right to touch her body.

The NSW Government will not allow pill testing at concerts, but wants to try to stop the drugs entering. Presumably there is a risk that younger people will bring them in if they are exempt from searches. Where will this end? Body cavity searches? MRIs outside concerts?

Prohibition will generally not work in the workplace, let alone the rock concerts. We need harm minimisation policies. This is not easy and it is not perfect, but it is better than prohibition.

Here is the NSW story in the NY Times, presumably with the unstated subheading, ‘Look what these mad Australians are doing now.’

www.nytimes.com/2019/11/06/world/australia/strip-search-children-drugs.html

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