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Category: Personal

22/05/2025

Tobacco Tax Rises

22 May 2025
I started it, but look what has happened now.

In 1983 I attended the 5th World Conference on Smoking and Health in Winnipeg, Canada. It was all about the health effects of smoking. There were no activist or political sessions and Stan Glantz of American for Non-Smokers Rights called an evening meeting for those interested. I gave a paper on BUGA UP, which was the only paper that had to be given again because the room was too small for the audience.

I met a very significant figure, William Weis of Seattle who had a paper on the price sensitivity of tobacco. He said that if the price of cigarettes went up 10%, total consumption would go down 4.5%, so if the rise was tax, the government would make money. He also said that young people were more price-sensitive than adults, so consumption by those under 18 would go down 12% and uptake by young people would also go down by 12%.

Thus tobacco tax was a good revenue measure and good for public health.
I came home and wrote to the health minister without effect, but I also wrote to the Anti-Cancer Council of Victoria (ACCV) and ACOSH, (Australian Council on Smoking and Health) who were in WA. They were the most active bodies on tobacco in Australia at that time.

Australian tax was low by international standards at that time, being 50%. Only the US was lower among developed countries at 36%. Denmark had the world’s highest at 85%.

The Australian tobacco growers were supported by the TISP (Tobacco Industry Support Program), which subsidised them as they could not compete on price with developing countries such as Zimbabwe. The Australian tobacco manufacturing industry, mainly British American Tobacco- AMATIL and Rothmans bought just over 50% of their tobacco from the Australian growers, who were mainly in Queensland, with about 20% in Victoria and about 3% in NSW. They did this although it was more expensive because the farmers were useful as a lobby group, and the tobacco was only about 1% of the final price anyway.

The ACCV took up the excise case and started to lobby the Federal government for the 1984 budget. At that time there were both Federal and state taxes.

The campaign against tobacco in Australia differed from those in other countries largely because of the existence of BUGA UP, which had first become active in 1979. In most countries, the health lobby had been beavering away for years with little success, as the tobacco industry simply funded political parties on the deal that they could say what they liked about tobacco, but not legislate against it till the next election, when they would offer the same deal.

The smokers were said to know the risks and were supposedly happy to take them. The Non-Smokers Rights Movements, who did not like the smoke, were the forefront of activism around the world, but the industry painted the battle as one between smokers and nonsmokers and asked for tolerance and understanding. This naturally translated into non-smokers putting up with the smoke.

Great store was placed on the medical evidence of a Japanese professor, Takeshi Hirayama, who published a paper in the BMJ in 1981 showing that wives of smoking men had a higher incidence of lung cancer than wives of non-smokers. Naturally the tobacco industry denied all this, and governments, paid to dither, did nothing except talk. The Non-Smokers Rights groups did make it a political issue and tried to use product liability cases to advance their cause.

In Australia, Geoff Coleman a still unknown activist and one of the three founders of BUGA UP reframed the debate, saying it was not a battle between smokers and non-smokers; Tobacco was a rogue industry, happy to kill people to make its profits, and buying the advertising industry and the politicians as part of this business model. The advertising industry similarly was happy to say anything that its clients wanted without regard for the consequences of the consumption changes that they achieved. Hence the BUGA UP acronym, Billboard Utilising Graffitists Against Unhealthy Promotions. Cigarette billboards were about half of all outdoor advertising at that time and by far the most prolific at points of sale, so that general stores were chiefly recognisable because they were covered in tobacco ads. The key BUGA UP concept was that anyone could paint (reface) a billboard and sign it BUGA UP, so there would be a unifying concept from a public point of view without any formal structure. BUGA UP also wanted to tap into the Australian larrikin image and to use humour to satirise the absurd imagery of the tobacco ads. There were also street protests and disruptions of tobacco promotions, which were happening in shopping centres, pubs and music venues as well as all the sports sponsorships. BUGA UP activists were arrested for graffiti vandalism or staying on premises against orders to leave, and the court cases were played for publicity, and to contrast that some people were being arrested for doing good, while the industries were getting away with doing bad.

It must be mentioned that when tobacco advertising was banned from TV, the industry had switched to sponsorship, which meant that rather than paying the Telecaster directly, they paid the sport. This had two advantages; it was cheaper in terms of the amount of time that the brand was on TV, and it also gave them a political ally if there was any attempt to ban the sponsorships. They gave money to basically anyone who would take it, supporting cultural events and ethnic clubs to build the lobby, so while BUGA UP was winning the PR battle against the industry, it was getting its allies in order. This played out in Western Australia where the government tried to ban tobacco sponsorship in 1984 and was defeated. In Victoria the health forces were more successful with the Victorian Tobacco Act or 1987 raising tobacco excise to do three things; replace the tobacco sponsorships of just about everything with health promotion messages, have some grants for organisations that would promote health and fund some medical research. All the political opposition was bought out except the Tobacco industry itself. Health promotion foundations were created in Victoria, SA and WA, but the industry managed to get other State treasuries to stop the further spread of them by saying that they created the precedent of hypothecated taxes, which would reduce Treasury control over where money was spent.

Excise taxes were later rationalised so as only to be collected Federally after a High Court case ruled that States could not collect such a tax. (Ha v NSW in 1997, Ha was a tobacco wholesaler).

The rise of vapes is another story. As World Conferences on Tobacco and Health, (Later changed to Tobacco or Health) went on, the tobacco industry used to run parallel conferences in the same cities with tame doctors are produce a book of proceedings of these with summaries that took a very anodyne view of the tobacco problem, to encourage the idea that legislation was not really needed, edited by people such as Robert Tollison. These books were then sent free to public libraries, some of them mistaking them for proceedings of the world conference as the dates were similar. The tobacco industry also wanted to medicalise the whole issue of quitting, so that addiction was a medical problem to be treated by gradually reducing nicotine doses in lozenges or patches. Their conferences were often subsidised and created a market and a rationale for practitioners in Quit Clinics.

The technology of the quitting devices kept being ‘improved’ until they were a whole new drug delivery device, ready for a new market. Some companies that were ahead of the tobacco industry in their technologies were bought by the industry, who were taking advantage of the new social media market that could reach young people without older demographics being aware of what was happening. Some of the medical folk, obsessed by the carcinogenesis of tobacco, and influenced by harm minimisation strategies from hard drugs and AIDS advocated vapes as a quit aid, which immensely helped the tobacco industry in avoiding having to prove that vaping chemicals were safe; they just had to be better than cigarettes, an easy bar to clear.

At a political level, the last Federal Health Minister to take tobacco seriously was Nicola Roxon in the Gillard government. After this there were some Liberals, perhaps helped by vaping associated party donations, who felt that vaping should be encouraged, and certainly not regulated against. So instead of working hard to get the remaining lower demographic of smokers to quit, and linking vaping to smoking as other undesirable health behaviour, there was no real action, except on tobacco excise. This continued to be raised, so that the price was far too high for the poorer demographic who continued to smoke, so there was a huge margin of profit for chop chop, tobacco leaves from the farm, or for imported smuggled cigarettes.

The social marketing of vaping products had gone on unabated and medical research was trickling in showing that as many young people started vaping and went to smoking as ever managed to use vapes to quit. There were a few cases of deaths from vaping and scientific evidence that the cilia, the tiny hairs that move to mucus up the bronchi to clean out the lungs were adversely affected, but the industry has naturally ignored these and have reversed the onus of proof politically. Now they do not have to prove it is harmless, the medical profession will again have to prove it is harmful and get this through the political process. Last time this took 50 years; from smoking being linked to lung cancer in 1950, to a ban on indoor smoking in NSW in 2000.

Now with no action except excise rises since the election of the Abbott government in 2013, Labor is trying a prohibition approach that is unlikely to succeed. The vaping industry marketing is significantly controlled by tobacco and vapes are largely distributed by organised crime. An article in the SMH stated that there were 60 tobacconists for every McDonalds (SMH 19/5/25). Many recent stories of firebombing of tobacconists emphasise the criminals’ power. The challenge to stamp out vaping by medical evidence and the marketing of such evidence is now a huge challenge that I no longer have either the expertise nor the energy to tackle. Here is an update from the SMH.

The tobacco tax is a disaster playing out on our streets and in our budget
By Shane Wright
SMH May 19, 2025
The tax and policing approach to tobacco across this country is becoming a social, economic and legal disaster.
This disaster is playing out in our streets – from more than 120 arson attacks across Melbourne that have claimed at least one life to dodgy looking tobacco shops in Newtown and small “farms” in rural areas with unusual-looking cash crops, it’s clear to anyone that the current system is failing.
Not only is criminal activity becoming the norm, hundreds of thousands of ordinary people are being dragged into breaking the law every time they light up a cheap ciggie.
America launched a war on drugs, and it failed. What’s going on in this country at present is eerily similar.
Not only have ever-more expensive cigarettes created market opportunities for organised crime, but they’ve also provided smokers with products that could be worse for their health than legal products.
That’s the human side of ever-increasing excise rates being used to tax smoking out of existence. There’s also the economic side.
Treasurer Jim Chalmers is dealing with what is now a $43 billion hole in tobacco excise since 2020 that affects the provision of services, welfare and infrastructure to the entire community.
That’s due to governments of both political persuasions overestimating just how much revenue their assault on tobacco would reap for the budget bottom line. And, as revenue has fallen, governments have spent more money on trying to make up for the cash shortfall.
The situation is so out of hand that in his pre-election budget, Chalmers pumped an extra $156.7 million over the next two years into increased efforts to police the illicit tobacco trade. That was in March.
In January last year, the government announced an extra $188.5 million over four years for Border Force to work with the states in a “co-ordinated effort to tackle all aspects of illicit tobacco”.
That extra policing was partly paid for by another increase in tobacco excise, worth 5 per cent a year for three years, that began on September 1, 2023. At the time, it was estimated it would garner an extra $3.3 billion in excise revenue.
But it’s clear that it did not. In the two years since that excise increase was announced, excise collections for 2023-24 and 2024-25 have been downgraded by $9.3 billion.
Apart from the extra resources pumped into state health departments, the country now has its own version of Eliot Ness in the form of Erin Dale, a senior Border Force official who is the nation’s “Illicit Tobacco and E-cigarette Commissioner”.
Public health advocates in this country have led the way in trying to reduce tobacco consumption. From ending television commercials to sports sponsorship and plain packaging, they’ve made huge strides in making cigarettes as unattractive as possible to potential new smokers.
Price – through tax – has been another key element to their strategy. But somewhere along the line, the key economic concept of substitution has been ignored.
In this case, the substitution is whether people switch to chemist-only vaping products or get their fix via the black economy. And guess what? Australians have done both.
Given the way smokers are more likely to be lower-income earners, every large lift in excise disproportionately affects those least able to afford it. The assumption was that these people would give up.
Instead, the economy came up with another solution – a thriving, illegal but cheap market.
Public health officials, police and politicians have to come up with another way to deal with the explosion in illicit tobacco. The starting point has to be an acknowledgment that there is a cohort of people who will continue to smoke, no matter the health impacts.
And this approach has to cut the cord between federal governments and higher excise as an easy way to repair the budget. Tobacco excise is just a sign of the problems for the budget that are coming as petrol- and diesel-powered vehicles give way to electric ones.
At the end of The Untouchables, Ness is asked what he was going to do if Prohibition came to an end.
“I think I’ll have a drink,” he replies.
We don’t want a situation where people just light up and do irreparable damage to themselves and their loved ones. But we can’t continue with a series of policies that are not working.

26/02/2025

Vale Marg White

26 February 2025

Marjorie Irene White (just call me Marg) died on 18 December 2024. She was the doyen and major organiser of the Melbourne activists of MOP UP (Movement Opposed to the Promotion of Unhealthy Products) and later BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions). The difference between the two groups was that MOP UP confined itself to legal activities, and BUGA UP did not.

Marg was born in 1930 in Macksville, the only child of Frank and Irene Macrae. Frank was a farmer, who took Marg everywhere he went, so she developed a handy range of practical skills and good self confidence Her mother was a schoolteacher and she helped her mother and acquired a love of teaching.

They moved to Kendal in 1937 and she was somewhat protected from the Depression as her father could grow food and her mother’s teaching job remained. Later Kendal, a town of only 600 people, was where the troop trains stopped on their way to northern Australia and Papua New Guinea. She was a popular youngster as she took treats to the troops. Frank bought a small weekender at Bonny Hills where the family spent holidays. He later retired there.

She was very musical and a good student, topping NSW in geography and going on to Uni in Armidale and then Sydney Uni where she did a BA and Dip Ed and specialised in early childhood education, believing that lessons learned early were the most important. She met her future husband, David Ogilvie White, who had got into medical school at 16, but was more interested in playing chess. She pushed him to do more work and actually pass. They married in 1954 and went to ANU in Canberra where she met Bob Hawke and Hazel, resulting in a lifelong friendship. Consistent with her idea that everyone should reach their full potential she encouraged Hazel to get a degree when Bob was not keen on this. They remained great friends, with Bob and Hazel staying with them in Melbourne. David’s career blossomed and he rose in the academic ranks becoming Professor of Virology and head of Infectious Diseases at Melbourne University.

She became involved with MOP UP (Movement Opposed to the Promotion of Unhealthy Products) and had quite a large corps of medical students who were keen to help. Some of their stunts were very effective. MOP UP made a graveyard with satiric names based on tobacco brands and handed out leaflets outside the Marlboro Australian Tennis. The sponsorship was dropped in 1985. The Royal Philharmonic Orchestra was met with a group of protesters in black tie outfits playing mock instruments as ‘The Royal Carcinogenic Orchestra.’ They also dropped their Benson and Hedges sponsorship. MOP UP continued street theatre and leafleting while BUGA UP refaced cigarette billboards, and occasionally alcohol or offensively sexist ones. Marg quietly worked as an organiser, but not merely of the activists, keeping in contact with the political and medical establishments, writing letters and encouraging progressive initiatives.

She was happy to contribute directly to the BUGA UP campaign; standing at a tram stop in a houndstooth tweed suit, complete with cape, she would reface the cigarette ad on an arriving tram, then stand back, spray can under her cape looking like the super-respectable middle aged schoolteacher that she was. If you were getting on or off the tram or blinked you would have missed it.

At that time the tobacco industry used ‘shop panels’, cigarette ads about 50x90cm stuck on each side of the doors of convenience stores with two-sided tape. They stuck well enough, but could be prised off easily with either a claw hammer or small jemmy. Marg went out with an activist one night to clean up the shop panels which her companion removed and stacked in the backseat of her car. There were few security guards and no CCTV cameras in the mid 1980s, but they were spotted and hailed. Her companion ran off and she drove away, but the Police had been alerted, so she was chased with Police lights flashing and sirens blaring. She pulled over and the officer who came to car window was flabbergasted to see a respectable grey-haired woman. ‘What are you doing?’ he asked. ‘I am just on my way to pick up my daughter from the ballet’ answered Marg calmly. ‘Oh, sorry lady’, said the Policeman. The story goes that he got a hard time back at the station and was told, ‘Yes, that was her; that is the exact description’. Meanwhile Marg hurried home and put the shop panels under the house in case the police returned. They never did.

Marg was a philanthropist and gave money to the Melbourne Symphony Orchestra and the Australian Ballet, as well as the Australian Conservation Foundation. She was an environmentalist and fought for causes she believed in, successfully funding an expensive QC to stop a canal development at Laurieton in NSW near the family weekender at Bonny Hills. The success of that case became a template for similar residents’ actions.

She was active in many roles in the Australian Democrats and became President of the Victorian division when they were a significant force in Australian politics. At home, she nursed her husband who had liver failure, probably occupationally acquired.

Her greatest achievement is probably the Victorian Tobacco Act of 1987. The Western Australian government had tried to ban tobacco advertising in 1983, but were beaten by sports associations that complained that they would founder without tobacco money. So the Victorian Tobacco Act sought to increase tobacco tax and use the money to buy out the sponsorships of sports, cultural events and all the other entities that had been bought by tobacco, as well as funding medical research and doing health promotion to take up the empty billboards among other initiatives. It was the first Health Promotion Foundation in the world, and the legislation passed by one vote. Nigel Gray, doyen of the Establishment and head of the Anti-Cancer Council of Victoria said that the legislation would never have passed without the public support generated by the activist groups, of which Marg was a critically important member.

She is survived by three daughters and two grandchildren.
Marjorie Irene White (just call me Marg) died on 18 December 2024. She was the doyen and major organiser of the Melbourne activists of MOP UP (Movement Opposed to the Promotion of Unhealthy Products) and later BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions). The difference between the two groups was that MOP UP confined itself to legal activities, and BUGA UP did not.

Marg was born in 1930 in Macksville, the only child of Frank and Irene Macrae. Frank was a farmer, who took Marg everywhere he went, so she developed a handy range of practical skills and good self confidence Her mother was a schoolteacher and she helped her mother and acquired a love of teaching.

They moved to Kendal in 1937 and she was somewhat protected from the Depression as her father could grow food and her mother’s teaching job remained. Later Kendal, a town of only 600 people, was where the troop trains stopped on their way to northern Australia and Papua New Guinea. She was a popular youngster as she took treats to the troops. Frank bought a small weekender at Bonny Hills where the family spent holidays. He later retired there.

She was very musical and a good student, topping NSW in geography and going on to Uni in Armidale and then Sydney Uni where she did a BA and Dip Ed and specialised in early childhood education, believing that lessons learned early were the most important. She met her future husband, David Ogilvie White, who had got into medical school at 16, but was more interested in playing chess. She pushed him to do more work and actually pass. They married in 1954 and went to ANU in Canberra where she met Bob Hawke and Hazel, resulting in a lifelong friendship. Consistent with her idea that everyone should reach their full potential she encouraged Hazel to get a degree when Bob was not keen on this. They remained great friends, with Bob and Hazel staying with them in Melbourne. David’s career blossomed and he rose in the academic ranks becoming Professor of Virology and head of Infectious Diseases at Melbourne University.

She became involved with MOP UP (Movement Opposed to the Promotion of Unhealthy Products) and had quite a large corps of medical students who were keen to help. Some of their stunts were very effective. MOP UP made a graveyard with satiric names based on tobacco brands and handed out leaflets outside the Marlboro Australian Tennis. The sponsorship was dropped in 1985. The Royal Philharmonic Orchestra was met with a group of protesters in black tie outfits playing mock instruments as ‘The Royal Carcinogenic Orchestra.’ They also dropped their Benson and Hedges sponsorship. MOP UP continued street theatre and leafleting while BUGA UP refaced cigarette billboards, and occasionally alcohol or offensively sexist ones. Marg quietly worked as an organiser, but not merely of the activists, keeping in contact with the political and medical establishments, writing letters and encouraging progressive initiatives.

She was happy to contribute directly to the BUGA UP campaign; standing at a tram stop in a houndstooth tweed suit, complete with cape, she would reface the cigarette ad on an arriving tram, then stand back, spray can under her cape looking like the super-respectable middle aged schoolteacher that she was. If you were getting on or off the tram or blinked you would have missed it.

At that time the tobacco industry used ‘shop panels’, cigarette ads about 50x90cm stuck on each side of the doors of convenience stores with two-sided tape. They stuck well enough, but could be prised off easily with either a claw hammer or small jemmy. Marg went out with an activist one night to clean up the shop panels which her companion removed and stacked in the backseat of her car. There were few security guards and no CCTV cameras in the mid 1980s, but they were spotted and hailed. Her companion ran off and she drove away, but the Police had been alerted, so she was chased with Police lights flashing and sirens blaring. She pulled over and the officer who came to car window was flabbergasted to see a respectable grey-haired woman. ‘What are you doing?’ he asked. ‘I am just on my way to pick up my daughter from the ballet’ answered Marg calmly. ‘Oh, sorry lady’, said the Policeman. The story goes that he got a hard time back at the station and was told, ‘Yes, that was her; that is the exact description’. Meanwhile Marg hurried home and put the shop panels under the house in case the police returned. They never did.

Marg was a philanthropist and gave money to the Melbourne Symphony Orchestra and the Australian Ballet, as well as the Australian Conservation Foundation. She was an environmentalist and fought for causes she believed in, successfully funding an expensive QC to stop a canal development at Laurieton in NSW near the family weekender at Bonny Hills. The success of that case became a template for similar residents’ actions.

She was active in many roles in the Australian Democrats and became President of the Victorian division when they were a significant force in Australian politics. At home, she nursed her husband who had liver failure, probably occupationally acquired.

Her greatest achievement is probably the Victorian Tobacco Act of 1987. The Western Australian government had tried to ban tobacco advertising in 1983, but were beaten by sports associations that complained that they would founder without tobacco money. So the Victorian Tobacco Act sought to increase tobacco tax and use the money to buy out the sponsorships of sports, cultural events and all the other entities that had been bought by tobacco, as well as funding medical research and doing health promotion to take up the empty billboards among other initiatives. It was the first Health Promotion Foundation in the world, and the legislation passed by one vote. Nigel Gray, doyen of the Establishment and head of the Anti-Cancer Council of Victoria said that the legislation would never have passed without the public support generated by the activist groups, of which Marg was a critically important member.

She is survived by three daughters and two grandchildren.

14/02/2025

Vale Brian Robson- an Obituary

14 February 2025

Brian Robson, a significant but understated helper in the fight against tobacco died recently.

Here is my obituary for him.

I met John Brian Robson (known as Brian) at a Non-Smokers Movement of Australia (NSMA) meeting in 1980.

NSMA had been started by Brian McBride in 1976 when he sued a bus driver for deliberately blowing smoke in his face some time after smoking was banned on buses. No one wanted to be a witness in the case, so he delivered the subpoenas to the bus passengers in person, as usually the same people sat in the same seats every day. To his pleasant surprise they turned up as witnesses in Court and the bus driver was convicted of assault and fined $1. A precedent had been set. In those days everyone’s name and address were available in big phone books, so Brian McBride had some abusive phone calls and had set up the Non-Smokers’ Movement of Australia (NSMA) as a support group and to further the cause of smoke-free indoor air. Brian Robson was there before I had joined.

Some of the Non-Smokers movement members were in BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions), which was a smaller group who used to spray satirical messages on billboards (mainly but not exclusively tobacco) to draw attention to the harm the products did. BUGA UP also protested in shopping malls and performed street theatre to draw adverse attention to tobacco promotions. The BUGA UP folk never mentioned their other activities at NSMA meetings, so it took a while to realise that Brian was a ‘member’ of this group. ‘Member’ is perhaps the wrong word for being part of BUGA UP, as legal advice was that since many of their actions were illegal, being a ‘member’ would have made one part of a criminal conspiracy. So no ‘members’; t just had people who were willing to act and came along when contacted. Brian was one of them. He was short in stature and quite shy at a personal level, but a good photographer and extremely good at his work, which was the emerging discipline of computer programming and database management.

He used to come to the NSMA demonstrations, but was rarely in the photographs, mainly because he took them. Some demonstrations were at the airport to try to achieve smoke-free air travel. He had a sign that said ‘Sorry Okker the Fokker is Chokker’, a reference to the Fokker Friendship aircraft. I asked him what it meant and he said, ‘Well it really doesn’t mean anything, but people like it’. He was right, of course, and his sign made the public more likely to see the protest in a positive light. It was typical of him; gentle, kind and understated.

He tended to work behind the scenes collecting and processing the photos and slides of both the NSMA and BUGA UP activities for newsletter or pamphlets or reproducing slides for when BUGA UP ‘members’ were asked to speak at meetings or courses on the issue that they had raised, the effect, responsibility and regulation of advertising. He was something of an archivist, but his main contribution was the development of websites and databases which allowed NSMA to be far more effective than it would have been otherwise. He helped a large number of worthy causes with their databases and websites, usually for free.

As a professional engineer at Telecom Brian rose to the position of Computer Coordination Manager. Arguably, he could have qualified for the epithet ‘computer nerd’ as he knew his professional subject really well, but gave no attention to issues of fashion, wearing clothes long after they had seen their best years. He was promoted on the merit of his knowledge, but admitted Computer Coordination was a hopeless task. Every department in Telecom had been allowed to purchase and develop whatever software it chose, so there were a myriad of incompatible programs. Meetings to resolve this usually involved managers much higher up than Brian trying to convince everyone else that their system was the best and everyone else should change to it. It was desirable to move to a new system for everyone and technology was changing. Telecom set up a group called ‘TIME- (Technical Innovation Management Environment) to see what technology was proven and should be adopted. Brian despaired. He said that by the time something was ‘proved’ it was obsolete. Telecom had to ask its IT experts and buy what they suggested. ‘We won’t be right all the time, but we will mostly and TIME merely guarantees that we will be way behind the times’, (especially as membership of TIME related to one’s position in the hierarchy rather than one’s IT knowledge).

Naturally Brian normally kept his BUGA UP work well separated from his Telecom duties. But Brian had a lot of phone extensions in his little section, so had agreed to host a BUGA UP answering machine. Unsurprisingly, there was a complaint to Telecom about this phone number’s ‘illegal activities’. Telecom vowed to trace the call and take all measures to stop it. Eventually the dedicated sleuths arrived at Brian’s section and he asked them what they were looking for. They told him of their mission to trace where the answering machine was. “Oh” said Brian. “It would be embarrassing for Telecom if it were found on one of our own extensions, wouldn’t it?” The sleuths suddenly realised that their mission had to change its focus. “Why don’t I find the problem and deal with it?’ offered Brian. “Yes, that sounds like the best solution,” the sleuths agreed. Brian took the answering machine home.

BUGA UP was tackling tobacco sponsorship of culture and sport. The Winfield Cup for Rugby League had a bronze statue of a large and a small footballer caked in mud walking off after a grand final. BUGA UP devised the ‘Windfailed Cup’, which had a large doll putting a cigarette into the mouth of a small doll. Brian made and photographed it. It was publicised on the ABC with Roy and HG. Many poster of the cup were made and sold by BUGA UP.

Telecom became Telstra and management decided to downsize. Big payouts were offered as redundancy. The longer you had been there and the more you knew, the more you were paid to leave. Brian qualified for a big payout and got ready to go. Then management decided it was losing all its expertise, so devised a knowledge questionnaire for employees seeking redundancy. If you passed it, you couldn’t leave. Brian reckoned he could do it all, so spent his last few weeks dodging the questionnaire. He left and was immediately re-hired by a private computer firm who had, you guessed it, a contract with Telstra. They were amazed at his knowledge and paid him as much in 2 days as he had been paid in a week and he had totally flexible hours, doing part of what he had done before.

Brian’s working career transitioned over the years from programming on mainframe punched cards to desktop database programming. It was in the late 1980s when Brian created a successful job tracking database system for photographic services at the Australian Museum.

Around this time, Brian, Ric Bolzan and Denise Greig, a plant photographer, formed “Diversity Media” to produce multimedia interactives on CD-ROM. It was one of the first Australian companies to do so, producing Plants of Australia, which was technically and financially successful. Unfortunately the newly emerging “internet” quickly killed off the CD-ROM multimedia market which made Diversity Media unable to capitalise on the investment in Brian’s core programming infrastructure to produce subsequent products.

He also worked for the newly created NSW Heritage Office in the late 1990s where he designed and developed a database for the State Heritage Register. When the database went online, it was one of the first in the world to use the new “internet” technology and it won a NSW Premier Public Sector award for technology. Brian is still fondly remembered by staff of the formative years of at the Heritage Office and much of the data and structure developed by Brian is still in use today.

As a true eccentric in that he had a few unusual interests, he continued to develop databases and websites either for money or for worthy causes such as the Bondi Beach website www.bondibeachvillage.com, which provided both historical and current information on venues and activities. He personally checked out all the coffee shops.

He had particular interest in the abuse of apostrophes. He felt that grammar was completely going to pieces so called himself ‘Apostrophe Man’ and wrote to any supposedly reputable publication that dared to commit an error. It was a losing battle. He had a website www.sharoncolon.com where more egregious mistakes were photographed and documented, and scoured pulp magazines for absurd headlines; a happy hunting ground.

Originally a Grafton boy, he loved country music and went each year to the Tamworth Festival. Sharon Colon branched out into his other interests ‘The Fifties Fair’ and Rockabilly music, documented from 2003-2014 with lots of photos, but only two with him in them in 11 years.

He lived alone with 2 cats, and was found dead in bed at home when he uncharacteristically did not turn up for a lunch date. He will be missed by a number of his groups, locals in Bondi, Country music and 1950 rockabillies, his old Telecom and Heritage office friends, BUGA UP and the non-smokers, those concerned about grammatical errors, some software and database developers and those who respect consistent but respectable eccentricity. He is survived by his brother, David and his wider family.

http://www.sharoncolon.com/country/pics2013/rsh3379.jpg

14/02/2025

A Visit to East Timor- and New Year’s Eve at the Presidential Palace

2 January 2025

I have always been fascinated by the story of East Timor. It was very much a colonial backwater, a historical remnant of the Portuguese, who had first arrived in 1529 and fought with the Dutch until treaties in 1869 and 1893. Up till 1850, it had been under the Portuguese administration in Macau.

Timor was invaded by the Japanese during WW2, and East Timorese fought with the Australian and Dutch against them, running a guerilla campaign. Between 40-70,000 Timorese were killed as the Japanese seized food supplies and burned villages.

After WW2 it remained a Portuguese colonial backwater with minimal education or infrastructure development. In 1960 it gained the right to Independence, but was still under Portugal. Indonesia, under Sukarno, which was trying to get hold of West Papua specifically stated that it had no interest in East Timor. The small Viqueque revolt resulted in some improvements in education and some Timorisation of the civil service.

There was a revolution in Portugal in 1974 and the decolonisation of Mozambique and Angola speeded the decolonisation process, with a new Governor legalising political parties. Two groups emerged, the left-leaning Fretilin and the Right-leaning UDT (Democratic Timor Union), which was more a party of the elite and initially favoured continuing ties with Portugal. Indonesia had just eliminated the PKI (Indonesian Communist Party) in a bloody struggle, so were concerned about Fretilin. Whitlam. the Prime Minister in Australia, who supported the Indonesian takeover of West Papua, was concerned that there would be a non-viable state in the region.

Fretilin and the UDT were initially in coalition, but the Indonesian military made it clear the to the UDT that they would not tolerate a Fretilin government and the coalition broke up. On 11 August 1975 UDT mounted a coup, as they were concerned at the increasing popularity of Fretilin and asked for union with Indonesia and the Indonesians to help them.

Indonesia immediately invaded, and five Australian journalists, who were covering the story in Balibo disappeared without trace. It had been claimed that Fretilin were communists so the Australian and US governments took no action, either against Indonesia or in pursuit of the journalists’ fate. They became known as ‘The Balibo Five’. Only the Australian Democrats supported the right of the East Timorese for self-determination, and some sections of the Left of the ALP, who were held to silence, of course.

Fretilin campaigned in the UN for recognition, particularly Jose Ramos Horta and after 24 years in 1999 and in the presence of an economic crisis the Indonesians agreed to a referendum on self-determination. The referendum result, which was widely expected, favoured independence from Indonesia by almost 80%. But gangs of pro-Indonesian youth, helped by the Indonesian government went on a killing spree. It was estimated that 200,000 Timorese had died during the 25 year Indonesian occupation, many ‘disappearing’; and about a third from malnutrition. But immediately after the vote, the militias killed about 1,400 people and forced about 300,000 into West Timor.

The UN intervened quite quickly with UNMET, the UN Mission to East Timor, in which the Australians were first to arrive and helped stabilise the situation.

Once East Timor achieved independence in 2002, they had the problem of economic survival. Australia held negotiations about where the boundary would lie, which was critical because there is a lot of gas in the Timor Sea and it would depend who owned it. Australia bugged the room where the East Timorese cabinet were deliberating and insisted on the border being very close to their coast. A whistleblower revealed this bugging in 2004 and the Timorese appealed successfully to the International Court.

Australia withdrew from the Court process, but then in 2012 agreed to the border being the midline between the countries, which is the international norm. Thw whistleblower, codenamed Witness K and his lawyer Bernard Collaery, the ex-ACT Attorney-General, were pursued by the Australian government in the courts and convicted of breaching national security.

So I have always wanted to visit Timor Leste, and have finally made it for a10 day trip (not really long enough).

It is a 3rd World country, but seems to have a great sense of hope. It is an hour and half flight from Darwin, and about the same from Bali. There is not much information available to tourists, though a Lonely Planet and some other guidebooks are now available.

I have taken advice from a diplomat friend and will be going in a car with a guide, (the expensive rich person’s way to go that I have always despised) so I will not be giving advice on the cheap local buses that go between the major cities and are quite cheap.

Our guide, Guido (short for Egidio Da Purificatcao Soares of Timor Sightseeing) was brought up on a farm in the western part of the country and recalls as a 14 year old his whole family were threatened by gangs immediately after the referendum. The gang asked his father did he want to go to West Timor or stay in East Timor. He says that he father wisely said that the family wanted to go, because if he hadn’t they would have been assumed to be in favour of independence and massacred on the spot. They had had 14 cows and had already sold some, but took a few in a truck as they went to West Timor. He said that at the border the Indonesians threw them out of the truck as if they were sacks of potatoes, searched the truck then threw them back in in the same way. They sold the cows for a pittance and lived in a tent in Indonesia for 3 weeks until the UN had negotiated with the Indonesians and the ‘refugees’ were allowed to return. He said he was pleased to see the Australian forces at the border.

He commented that in the Portugese times there was no electricity except in small parts of Dili and the Portugese generated their own on their properties. The Indonesians had improved infrastructure and electricity and introduced universal education, but anyone who was thought to support Fretilin or independence simply disappeared.

As we were here on New Years Eve, I wondered what to do and assumed that we would watch the fireworks on the beach. Guido suggested we go to the Presidential Palace. I assumed that this was impossible for a tourist. Not so, the Presidential Palace is open to all on New Year’s Eve. So we went. It has a large concreted area about the size of 3 football fields in front of it, with lawns about twice that size again. There was a stage set up and a dozen life size nativity scenes all the way up the wide drive. The military at the gates welcomed us and said that they would be giving out free food and drinks at 9pm. There were quite a lot of people, but it was not crowded early, with a lot of young families and kids with balloons and flashing lights. The state had popular local singers, with replays on some big TV screens like at a football match. There was a wonderful festive atmosphere. I held my phone up and started to take a video pan to try to capture the atmosphere. As I did so a man came close and thrust something into my spare hand. I stopped filming and looked at him. It was the Prime Minister, Xanana Gusmao handing out ham and salad rolls and fruit juice. He had 3 young minders in T shirts merely carrying boxes of rolls and drinks. Naturally I pursued him and asked for a photo, and he very courteously asked me my name and where I came from. The event went on with presentations to people who have obviously done good, and also what seemed like a very long sermon, but of course, apart from the MC breaking into English to welcome foreign visitors, the whole thing was in Portugese. At about 9pm, some military wandered around and urged us to get some of their free food from the trucks near the gates. They obviously have a very good relationship with the populace. The President Jose Ramos Horta arrived with the Cardinal and about 20 ambassadors and made a speech at about 11 followed by one from Xanana Gusmao.

They had a table in the middle of the open area with seats for the dignitaries. At midnight there was the countdown, a lot of fireworks (no, not quite as good as Sydney), and the broke out large amounts of champagne and cut a huge 2025 Fruit cake and gave some to those nearby including us. It was like going back 50 years, where everyone was trusted, there was no security and the largesse was universal.

East Timor is in an interesting time. The population is very young and full of hope. They want to develop tourism and also the Sunshine gas project which is being done by Woodside and the Australians in the Timor Sea. Obviously this will be a financial lifeline, but not good for a warming planet. I asked Guido if we could go to the south of the country where all this is to happen. He said, ‘Yes, but there is nothing to see, it is just coastline at present’. He took some Spanish folk there a short while ago who were doing a feasibility study for a gas platform. So I will see the sights including Balibo and the Museums of the Revolution in Balibo and Dili, which was not open this week. I may revise this post after those visits.

East Timor is currently the least visited country in Asia. This is worth changing.

14/02/2025

Vale Brian Robson

14 February 2025

Brian Robson, a significant but understated helper in the fight against tobacco died recently.

Here is my obituary for him.

I met John Brian Robson (known as Brian) at a Non-Smokers Movement of Australia (NSMA) meeting in 1980.

21/12/2024

Vale John Marsden

20 December 2024

We were all saddened to hear of the death of John Marsden. He was certainly the greatest Australian writer of books for adolescents in my lifetime.

I knew him well. He was in my class at boarding school and we were in the debating team together and rivals for the oratory prize. He was a day boy.

He used to wait at the bus stop and talk to the more junior boys there. This was thought of as a bit unusual. No one usually took an interest in kids younger than themselves. Older kids usually went to the library and only appeared just before the bus went. He also did not catch the first available bus, but stayed at the bus stop talking- not many people realised that. It was not until years later that the reason became known to some.

His father hit him frequently and he did not want to go home. Years later he told the story that he had been sitting on his mother’s knee when he was quite young and she had asked him. ‘Do you love me?’ He had replied ‘I don’t know’, and she promptly pushed him off her knees onto the floor. The idea that the question needed to be asked is so odd that the reply becomes less so. There is no doubt that his childhood was very unhappy.

We went out one evening to a debate and came home by train. Some of our group smoked and then when he got home he unfortunately hung his coat over a chair and the cigarette packet came tumbling out. His father gave him a beating as usual, and insisted that all his friends, i.e.us, come to the car park to be ticked off by his father or he would take the matter to the Headmaster- a very serious matter at that time. His father duly drove up, wound the window down and berated us, standing in the car park. John was quietly dying of embarrassment but, hey, that was life at school. But while we were thinking about getting away from school and its problems, he was thinking about how things could be better and talking to kids at their level about their issues. He understood adolescent kids because he talked to them a lot.

He left home soon after he left school and had some years of financial and personal hardship, with some of the parents of his schoolmates helping him.

I lost track of him for some years, as neither he nor I were very active in the old boys for a long time as he had moved to Melbourne. I had become aware of his writing and read ‘Letters from the Inside’, the correspondence between two 15 year old girls who start as pen pals. One is in gaol, though it is not clear why, and the other lives in fear of a violent brother. The fact that he could write so credibly from the perspective of adolescent girls was quite extraordinary, and he left readers tantalised at the end. He met my son when he was just a baby but later my son became a huge fan of his Tomorrow series. He was so enthusiastic about John’s book that his teacher credited him with getting the whole class to read it.

John stopped writing to set up his school, funded considerably from his book royalties and embodying the ideas he had developed from looking at the dysfunctions that he had experienced and the successes he believed were possible.

When John came back as the honoured speaker at a school reunion I caught up with him, which was great. He was working very hard, running the school that he had started with a skeleton administrative staff, and all the while writing to the people who wrote to him, answering their questions, helping them with their fears and firing them with his enthusiasm. But he was still smoking and it had taken some toll of his health so (as usual) I urged him to Quit and put in place a succession plan at the school. He did those things, though I do not claim it was due to my urgings.

I had always had the dream that I would go to his school and teach for a while, things that kids are not taught these days, perhaps in the time after exams when the kids are merely filling in time waiting for the Christmas holidays, or speaking at a speech day. Sadly, it never happened. When I went to Melbourne, it was either term time and he was too busy, or holidays when he went away.

He died suddenly, though perhaps not unexpectedly, so this will not happen now. As we get older, we need to be more urgent with our intents.

Fortunately he will have many friends and many writers able to give credit to his greatness, but also to understand and express his warmth and his humility.

16/02/2024

‘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.

09/11/2023

Burma/Myanmar Sportswashing

9 November 2023

I visited Myanmar (Burma) in December 2017.

Aung San Suu Kyi, the Nobel Peace prize winning daughter of the founder of modern Burma, who was immensely popular with the people had been elected in a landslide in 2015. She and her party had boycotted the 2010 elections as farcical, but the military dictatorship had allowed her to stand in 2015, where she had won with 86% of the parliamentary seats.

Despite this win, the military junta still refused to yield power and kept the critical portfolios in the Cabinet, so she was nominally in charge and trying to change the system but her hands were largely tied. It was hard to get anyone to talk about politics, and few spoke English, but I had enough contacts to let me in on the situation.

It was a third world country trying to develop tourism. It had some relatively modern tourist buses but few hotels of a reasonable standard. (This did not bother me as a lifetime backpacker). Most cars were old, but there were a significant number of modern ones. The only feature of these was that they were right hand drive in a country that drives on the right, so the drivers were on the wrong side when it came to overtaking. It was because Japan had made a number of recent model second hand cars available and these had been snapped up.

Yangon, the biggest city and historical capital had a building that should have been the Parliament and it was in quite good condition but mothballed and currently not used for anything. The city was third world, crowded and prone to blackouts, so many buildings had diesel generators in the street outside, which were turned on when the blackouts came, making pretty bad pollution worse.

The people were friendly and courteous, and keen to develop the new tourism industry that had opened up under the same pressure on the military government that had led to the elections. There was a palpable tension between the population and the military, who moved around with surly expressions as if they knew that they were hated, but were not going to give ground.

This was very evident in Mandalay, the second largest city, which has an old palace in a large fortified area, complete with a moat. The military have taken control of all but the central palace with signs forbidding anyone walking in the extensive (neglected) gardens. They have a large depot within the grounds and a surly military guard post at the gate that inspects passports.

The other major expression of this separateness was in Naypyidaw, the capital. This city was recently built with Chinese money and is in the mountains about 3 hours drive from Yangon, presumably to make it less vulnerable to possible revolution. It is very modern with 8 lane highways with absolutely minimal traffic. The foreigners were in a cluster of large modern hotels, again Chinese-built. The hotels were remarkably cheap for their standard, but I noted that at 9pm there were almost no lights on in any of the rooms and there were only about 20 people for breakfast in our large international-standard hotel. The foreign hotel area was a bus ride from where the people lived, and that was not a large area. The National library was a modern air-conditioned building, not partially large. We were about the only people in it apart from the staff. It was on a bus route, but nowhere near any population centre.

Four years later, in February 2021, there was a military coup and Aung San Suu Kyi was arrested on a number of charges related to national security. She has been in prison ever since on charges that the western countries have called politically motivated. It seems that her major crime was to use a two-way radio phone network that was not accessible to the military junta. Her economic advisor, Australian Professor Sean Turnell was also tried without an interpreter and gaoled. He was released in November 2022 after 21 months in detention and representations from the Australian government. There was some resistance to the coup and some people were killed. Resistance is ongoing and almost certainly widely supported, but it has had minimal publicity in the western or Australian media since Prof Turnell’s release.

The reason for this post is that a soccer team from Myanmar with strong junta connections is to play Macarthur FC in Sydney shortly. This looks like a sportswashing exercise to legitimise the government and lessen its isolation.

I suggest that you write to Penny Wong and ask that they not be given visas www.pennywong.com.au/contact/, and to Macarthur FC and ask that they not play them, email: admin@macarthurfc.com.au. Here is the request from the Australian Coalition for Democracy in Burma:

https://scontent.fsyd3-1.fna.fbcdn.net/v/t1.15752-9/384547058_856337555857136_1438592052866809960_n.jpg?_nc_cat=106&ccb=1-7&_nc_sid=8cd0a2&_nc_ohc=d416jFlBrW8AX8aY4cQ&_nc_ht=scontent.fsyd3-1.fna&oh=03_AdQLV1CGyViy42LJ37Vj04hsMufoe42jxyxxt5uM6PUNPg&oe=6573B503

04/04/2023

Classification of Impairment

4 April 2023

I was lucky enough in my surgical training years to have most of a year working as neurosurgical registrar for Dr John Grant. He set up the 1st spinal Injuries Unit in Australia saying that while everyone was looking for a miracle cure that would allow injured spinal tissue to repair, most paraplegics were dying of bedsores or infections coming up their urinary catheters and much better practices and training was needed.

He went to England in 1960 and with Sir Ludwig Guttman started the Stoke Mandeville games, the precursor of the Paralympics. He developed the Paralympic Games to help his patients, who were mostly young men whose lives had been shattered after a catastrophic injury, often after doing something daring or unwise. Wheelchair athletics was a major part of this, as it gave the young paraplegic people something to strive for. John Grant became head of the Australian Paralympic movement and Chair of the Organising Committee of the Sydney 2000 Paralympic Games. My part was merely to help treat the spinal patients.

Later I moved into occupational medicine so as to fund my work in the anti-tobacco movement. There I found impairment from workplace injury and had to decide who could work and who could not. This got a nasty edge to it as insurers wanted people classified as fit, so that if they would not work their pay could be suspended. The Courts argued about this until the legal process was deemed so expensive that the American Medical Association worked with the insurance industry to devise a complicated medical examination which measured ‘Whole Body Impairment’ as a percentage. This was not supposed to simply translate simply into how much money an injured person was awarded, but of course that is exactly what happened. Since pain cannot be measured it had to be left out of the calculation, so you can have terrible pain, but if you have only lost a few measurable degrees of back movement, your percentage impairment may be minimal. The system also makes no distinction between an impairment and a disability. If you are a labourer and have a lower body injury and cannot work at all or are someone who works at a desk and can maintain their previous income, the impairment is the same. I have never learned the details of the system, as I think it a bad farce, but it is used to assess impairment in Australia, makes a lot of money for the doctors who do the medicals, and saves the insurers a fortune. Of course there are few who try to fake injury, but in my experience this is fairly rare, far rarer than insurance companies would have you believe.

But making an objective assessment of what a person can and cannot do is not easy, and so one is to pity the classifiers who want a level playing field by classifying people for the Paralympic Games. Given that each country wants to pick a team of winners and they classify their own athletes, it is little wonder that in some countries ‘intellectually disabled’ are as smart as anyone else, or that you cannot even notice a limp in some of the runners.

The 4 corners of Monday 2 April looked at the whole Paralympic Classification system and produced damning figures that 10 of 12 of the gold medal winning Spanish basketball were not disabled at all, and that in some areas 69% of the winners had minimal disability.

As this sad farce continues there is a huge kerfuffle lest the tiny number of trans athletes with the genetic advantage of having had male hormones might get an advantage over females.

John Grant must be turning in his grave.

26/11/2022

The IR Bill- two problems and a suggestion

25 November 2022

When I buy petrol, I sometimes ask the attendant how much he or she is paid. Often they glance at the CCTV camera and say that they cannot answer that. But the other morning early I asked an attendant who looked like a very tired student from the Indian subcontinent. Yes, she had worked all night, a 12 hour shift for $10/hour cash. I asked her how she thought she might get a decent wage. She replied, ‘Well, an Australian boss might help’. I took this to mean someone who paid an award wage.

As small business tries hard to exempt itself from ‘sector-wide’ bargaining, I wondered how she will fare if there is still no industry-wide award or no enforcement. What will change?

I have a friend who runs a small business and he says that although wages have not risen, neither have small business profits. I asked why? He said that the supply chain had ‘consolidated’ and took a larger share of the final price. One might note that Deliveroo just left food delivery, Amazon is taking an increased percentage of online retail sales, Airbnb takes an increasing percentage of accommodation spending, Uber has increased its percentage take from its rides, and Spotify pays very little to those who make their music. It is the Monopoly game in real life, the big get bigger and the frail are pressed to the rail. The view that the biggest problem small business has is big business seems a neglected truism. The question is whether this will or indeed can be addressed by Federal Parliament. The point is that competition drives down prices, but cartels and oligopolies develop if not stopped. A new book looks at this problem, Chokepoint Capitalism www.thesaturdaypaper.com.au/culture/books/2022/11/30/chokepoint-capitalism#mtr

Another aspect is that the system seems totally unable to restrain is the salaries of top executives. One person I know advised, ‘I always vote against the management salary increases at the AGM’. There is legislation that salary rises have to be approved by the shareholders, but it seems that the top executives always have enough proxies to ensure that they salary rises come despite the efforts of small shareholders like my friend. So I suggest legislation that stipulates that no executive may get more money than, say, 20 times the full time equivalent hourly rate of the lowest paid person in the organisation. It seems that a few hundred thousand at the top does not matter, but a few dollars at the bottom do. This needs to brought into perspective.