Doctor and activist


Notice: Undefined index: hide_archive_titles in /home/chesterf/public_html/wp-content/themes/modern-business/includes/theme-functions.php on line 233

Category: Personal

‘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.
Continue Reading

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

Continue Reading

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.

Continue Reading

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.

Continue Reading

Fire Bombing of Friendly Jordie a Litmus Test

24 November 2022

The fire-bombing of the Bondi home of Friendly Jordie on 23/11/22 will be a litmus test for the NSW Police.

Friendly Jordie is a comedian and political commentator who took on John Barilaro, famously staying at his luxury property while filming commentary critical of him. He was then accused of stalking Barilaro, using Police powers usually limited to terrorist suspects, which looked very much like abuse of Police powers.
He has a considerable audience, particularly among younger viewers.

Clearly this was a threat to him personally.

I have some experience of this. In 1983 I was living alone in Newtown in an upstairs bedroom and at about 3am I was woken by the sound of breaking glass downstairs. I looked out, but could see nothing. Quite quickly there was a smell of kerosene and immediately after the whoosh of a fire being lit and a raging fire in our back lane, like a car on fire. In some trepidation I ran downstairs, went to the back door, turned on the outside light and started to hose the back fence. There was no response from any neighbours and I reflected that in a house full of semi-detached houses almost everyone except me slept in the front bedrooms away from the lane. My hose did not have a nozzle, so I stood at the back door and had put my finger in the end of the hose to direct the water. There was an explosion and the light went out. This was pretty frightening, but it turned out that some of the water from my hose had squirted upwards onto the light, which had exploded, luckily a little away from directly overhead.

After a while the fire died down somewhat and I took stock of the situation and ventured to the back gate. A car was burning out close to the fence, but the fence was undamaged. I called triple zero and reflected on the situation. There was a World Congress of Advertising Agencies at the Opera House on and two days before, BUGA UP had staged some street theatre on the forecourt with a confession booth with ‘Redeematiser’ sign on it, and a ‘priest’ in a cassock urging advertisers to come in and confess their sins. I had been there to get interviews for my radio program ‘Puff Off- Australia’s leading program on smoking.’ An executive from the ‘Tobacco Institute’ had walked by and been conspicuously unamused.

The Fire brigade arrived very quickly, put the rest of the fire out and prised open the boot, which was empty. I waited for the Police for about an hour, then went back to bed. The Police turned up about an hour later, more than 2 hours after I had called and the officer smelled strongly of alcohol. I told him of my concerns about who might have been responsible for the incident, but he was quite dismissive. He said that people often set cars alight. I said that I had lived in the area for more than a decade, went for long evening walks and had never seen a car set alight. He said that he would get the chassis number from the number plate on the computer, (as he did not want to bother even looking under the now-cooled bonnet). Some years later there was a lot of publicity about corruption allegations in Newtown Police Station.

So there is a real question whether the fire bombing attack on Friendly Jordie will be investigated adequately. He has a far higher profile than I had, and fire-bombing a house is more extreme than torching a car. But his allegations touch Caesar nearer.

Here is the story in the SMH:

ARSON INVESTIGATION
YouTuber ponders suspect shortlist after latest attack
Sally Rawsthorne, Sarah Keoghan, SMH 24 November 2022
YouTube personality Jordan Shanks-Markovina, better known as Friendlyjordies, says he has a ‘‘long list of suspects’’ in the alleged arson attack on his Bondi home on Wednesday, the second time the address has been targeted in a week.
Police and Fire and Rescue NSW have launched investigations after the property in the eastern suburbs sustained ‘‘significant’’ fire damage in the early hours of the morning.
Shanks-Markovina, 33, who is an Australian political commentator and stand-up comedian, said yesterday he had a ‘‘long list of suspects’’ based on his work.
‘‘We’ve done some extremely dangerous reporting over the last year on a bunch of extremely powerful people and corporations; there are many people that would want to do that,’’ he said.
‘‘I do have a shortlist in my head of who I think could’ve done it. I would hope that the NSW strike force that is supposedly set up for fixated people and terrorists would be looking into this instead of a comedian and his team for six months straight,’’ he said.
Friendlyjordies producer Kristo Langker was charged by NSW Police’s Fixated Persons Unit in June last year and accused of stalking former NSW deputy premier John Barilaro. The charges were later dropped.
There is no suggestion Barilaro is involved in the alleged arson attack.
‘‘Someone has just tried to kill Jordan Shanks,’’ his lawyer, Mark Davis, said.
It is the second fire at the home, which is a subdivision, in a week. Davis said last Thursday’s arson attack hit the other dwelling mistakenly. ‘‘It’s the second time, there was an attempt [last week].’’
Shanks-Markovina yesterday posted an image of the fire to his Instagram account, captioning it ‘‘I’m still alive’’.
The YouTuber was not home at the time of the alleged attack because he couldn’t find his key, instead spending the night at another property.
Emergency services were called to Wilga Street by multiple neighbours just after midnight on Wednesday. ‘‘The fire is being treated as suspicious,’’ Fire and Rescue NSW’s Adam Dewberry said.
Specialist forensic police and dogs ‘‘trained in the use of detecting accelerants’’ will investigate the cause of the fire, he said.
NSW Fire and Rescue said it took crews half an hour to extinguish the blaze, which ‘‘caused fairly significant damage’’.
The home remained a crime scene yesterday, with detectives arriving at the address in the afternoon as the smell of smoke hung in the air.
‘‘Officers from eastern suburbs police area command attended along with Fire and Rescue NSW and found the veranda of the house well alight,’’ police said.
‘‘The fire was extinguished with significant damage caused to the home and an adjoining property.’’
Shanks-Markovina has been a YouTube personality for around a decade. He has interviewed Kristina Keneally, Tanya Plibersek and former prime minister Kevin Rudd among others.
Recent videos on his YouTube channel, which claims 627,000 subscribers, include ‘‘KFC Workers Confess Their Sins’’ and ‘‘Anthony Albanese: Enemy to Women?’’.

Continue Reading

Danny Lim Bashing a bad sign of the times

24 November 2022

Danny Lim is a regular at many protests. He is a very kind and gentle man, and his protests are quite individual and idiosyncratic with very humane values. He would never harm anyone, and the way he was thrown face first onto the tiled floor at the Queen Victoria Building by the Police is frankly a disgrace.

As the gap between rich and poor widens with neo-liberal policies and a welfare system which is starved of funds, the level of social frustration rises. Many times in Parliament I was asked to pass legislation which simply increased Police powers, mostly in response to an item in the media where some crime had occurred. There was never any question as to why the crime occurred, there was simply an increase in Police powers and usually the maximum fines or sentences. The Police Service was re-named the Police Force, presumably to reflect the same philosophy. No one ever asked if this would actually work.

I have formed the view that the defence industry increasingly uses the Australian War Memorial as a temple of militarism. A couple of years ago, Nick Deane of the Marrickville Peace Group asked me to help him hand out leaflets on Anzac Day that said, ‘Honour the Dead by Working for Peace’. So I dressed in suit, wore a discrete sign with the slogan on it and went to the edge of the public area in the Hyde Park ceremony and started handing out his leaflet. People took it, and most agreed that it was reasonable.

After a while a Police sergeant came and told me to move 150 metres away as I was ‘offending people’. I said that no one had been offended, (not that there is a law against offending people in any case) and I was not going to move, as I had a right to stand there. He said words to the effect of, ‘You will do what I tell you or you will be arrested and charged’. I told him that he was there to enforce existing laws, not make them up, and if he charged me he would merely be told by the Magistrate that he did not have a case. I agreed to move about 2 metres so he could save face. He was furious, and went off asking to find someone who was offended. He came back and we had a second altercation. I really thought that if I had not been in a suit and told him I was an ex-MP, I would have been thrown down and roughed up. It was a line ball as it was.

The Police are there to keep us safe, not remove people harmlessly expressing opinions, and certainly not to do so roughly. They must obey laws of reasonable behaviour the same as we should. Clearly pressure on them needs to be maintained. The presence of cameras on every phone will help in this- no longer will stories of people ‘falling over’ be believed.

Fortunately Danny has come out of hospital and seems OK, but the video below leaves little doubt that he was assaulted by Police.

www.smh.com.au/national/nsw/excessive-police-force-is-damaging-sydney-s-reputation-minister-told-after-danny-lim-arrest-20221123-p5c0no.html

Continue Reading

BUGA UP Nostalgia

16 November 2022

BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions) was most active fro m 1979-1985, and had a big effect on tobacco and smoking. It was also a high point in the demand for advertising to be responsible for the consequences of its use of its products.

In the end, the advertisers accepted a ban on tobacco to keep the threat of stronger regulation at bay. They cut back on sexism a bit and the movement to regulate them died down. So alcohol, gambling annd junk food ads have survived.

Here is a link to some of the TV programs from that time and a little after.

www.youtube.com/user/BUGAUPTube

Continue Reading

Submission to Inquiry into Online Gambling

11 November 2022

Dr Arthur Chesterfield-Evans

The Internet Problem

The issue of online Gambling is similar to many problems in that online gambling involves an area of activity that is largely beyond the direct control of the Australian Parliaments, or indeed any single Parliament.  The internet was designed to be anarchic, and so it is.

Programs to deal with gambling regulation are thus ineffective, but the limited terms of reference of this inquiry suggests that governments are not thinking in terms of what they can do at a systemic and global level and are turning instead to a focus on the individual.

Need for an Industry focus rather than an Individual Focus

It must be noted that where creating public health problems benefits an Industry, the response must be against that Industry.  Concentrating on individuals while the Industry markets to the world is a very inefficient strategy.  To use a historical example, the Tobacco Industry marketed with ubiquitous ads, sponsorships, product placements and many other techniques, yet wanted medical professionals and school education to be the only techniques used against them, framing the issue as personal choice (and responsibility) and ‘smokers v. non-smokers’ requiring courtesy (and no criticism and restrictions).

This is the situation that the Gambling Industry is in now. They demand to be able to market to the world, but want all harm minimisation programs directed at individuals.  They know that this is a winning strategy for them.

What the Federal Government Can Do

While it is true that the Australian Federal government has no effective jurisdiction over the internet, and does not licence or control the Hotels, Clubs and Casinos with their poker machines, it has control over Australian media advertising laws and also allocates grants to States.  The Federal government could ban all Gambling advertising on electronic media in Australia, and lessen grants to States in proportion to their revenue from Gambling. This would stop the States getting any benefit from gambling revenue, which they rely on quite highly.  Western Australia, which is missing out on Gambling revenue would certainly support this.

The ban on tobacco advertising and sponsorship has set a precedent for action on public health issues, and there was censorship of certain opinions that were antithetical to a national COVID strategy, so the idea of a ban on Gambling advertising is not new or radical.  VicHealth also replaced tobacco advertising with ads for healthy lifestyles and anti-Gambling advertising could replace ads for Gambling. The protest group, BUGA UP (Billboard Utilising Graffitists Against Unhealthy Promotions) in the 1980s used satire of tobacco advertising to sharpen the focus on the Tobacco Industry’s absurd imagery and callous disregard for the lives of their customers.  They won hearts for their Robin Hood approach to the entrenched power of the Tobacco Industry and set the world standard for action against tobacco, because compared to their actions, everything else became ‘moderate’.  But less recognised than their billboard campaign  was the re-framing of the debate from ‘smokers v non-smokers’ and ‘personal choice’, to a ‘Tobacco Industry campaign to make a profit even though it kills people’.  This reframing in the public mind allowed governments to stand up to the Tobacco Industry and forced political parties to eschew their donations (at least publicly).. 

Gambling Industry Strategy

The Gambling Industry’s ads are very clever, appearing to take the loser’s side to identify with (usually) him and dangle the prospect of a win, though of course this is statistically impossible in the medium term. They are perverting the idea of ‘mateship’ to a group Gambling session with a cheery comparison of who they are backing as they watch sport.  This would be very vulnerable to a satiric response, based on a commiseration as to which mug lost the most and a final comment that ‘gamblers are losers’.

Laissez-faire v. Health

The Federal government is responsible for the health of Australians and with an increasing percentage of health problems being related to lifestyle choices, the government cannot simply ‘leave health to the market’.  ‘The market’ will sell anything that makes money irrespective of whether it has good health outcomes or not, so leaving the national wellbeing to ‘the market’ is a highly flawed strategy as the government in the end picks up the tab for all problems. The Federal government should unashamedly promote sales and practices that are good for health and discourage things that are not.

Encouraging good personal decisions

Any reasonable management textbook will say that the best way to manage things is to have good decisions made at the lowest possible level within the organisation. Yet gambling advertising uses distractions and dreams of riches that are statistically extremely unlikely to encourage people to gamble, and thus not use their money wisely. If the ads said ‘Do not contribute to superannuation’, ‘Do not save’, Do not worry if you do not have enough money to feed your kids’, there would be a huge outcry.  Yet this is the outcome with a large percentage of gambling money received being from people who cannot really afford it.  The social problems created take an immense amount of effort from government and NGO charitable organisations to try to rectify them. Often they cannot.  This problem is entirely created because of bad decisions on gambling made by people who the Gambling Industry has conned.  It is exactly like people taking up smoking. It was portrayed as a bit of harmless pleasure, but when people were hooked, it did them immense harm.  Gambling is the same.

Need for Gambling Research

One the other problems of Gambling is that the research is funded by the industry, so its scope and nature are controlled.  The amount of harm that it does is poorly quantified, so that there is little evidence for those opposing Gambling to use in political debate. The lack of evidence and the lack of debate suits the Gambling Industry fine- they are more than happy to continue and extend the status quo.  Given that the Federal government is a major player in cleaning up the social problems created by the Gambling, it should insist that there be well funded research on the social consequences of Gambling, and the nature of this research should not be determined by the Gambling Industry.  The Gambling Industry in Australia is extremely large by world standards, perhaps the largest in the world apart from little enclaves like Monaco or Macau where the money is retained by the State and the social problems are either ignored or assumed to be manifest elsewhere.  The social indices of distress are very high in Las Vegas.  It might be said that the Gambling Industry in Australia is like the gun lobby in the US; it is almost unchallengeable.  This must change, and the Federal government must initiate the change.

Off-line Gambling

It is interesting that the Clubs lobby is under challenge at a state level.  The origin of this is uncertain.  There has always been a lobby against Gambling, and this may have been helped by the rapid rise in the inflation rate which is straining the family budget, particularly of disadvantaged people, who are the ones most affected by Gambling losses.  It is also no doubt helped by the revelations that the Casinos have happily laundered money for organised crime, by-passing their regulatory systems, and being perceived by organised crime as an easier target than foreign jurisdictions.  The public also notice that the Casino boards were well stacked with ex-politicians, who were presumed to be there to smooth the political pathway of the Casinos in their dealing with regulation or (even) enforcement. It might be noted that despite the huge amounts of money being laundered and the findings that the Casinos were not fit to have licences, their share prices have only suffered modestly, showing that everyone knows that eventually their licence will be restored and it will be ‘business as usual’. The public is also well aware that the charade, ‘’I had no idea what was happening’ from the politically connected people at the top, merely leads to a resignation or two, but there is no penalty on the individuals.  An aboriginal youth can go to gaol for petty theft, but laundering billions for organised crime merely leads a Casino director to a sojourn in the yacht club.  While the major political parties have been very reluctant to upset the Hotel and Club industry, as evidenced by the 20 year delay in introducing smoke-free indoor air legislation, the rise of the Teal candidates threatening once safe seats, has pressured the major political parties to take a more ethical stance, and also  blunted the financial advantage that support  from the pubs and clubs lobby gives to their campaigns. 

Online v. Off-line Gambling

But the final possibility for the pressure on the Clubs and Hotels may have come from the Online Gambling lobby. If it is assumed that people who want to gamble will use what is available, there is a real possibility that the lack of poker machines availability in pubs and clubs may lead to an increase in online Gambling.  Supporters of the pubs and clubs are quick to point out that the clubs are non-profit and spend their monies enlarging their premises and providing facilities in Australia, as well as paying at least some tax to State governments. If there were a change towards online Gambling this money would go overseas.  This overlooks the social context of gambling. Playing a poker machine is quite different  from going online, so there is unlikely to be a direct transfer, even if the online experience is made more similar.

Need for Federal Government Action on all Gambling

The lesson for the Federal government, however, is that Gambling must be discouraged at both the pub and club level, and online at the same time. Both have similarly detrimental financial consequences for the players and punters, though the industries are distinct. From the public’s point of view, it is worrying that the terms of reference of this inquiry neglect that issue of Gambling in pubs, clubs and the TAB, as it suggests that these influences have restricted the terms of reference.  The regulation of the internet is also a wider problem, which usually comes into focus with the issues of inflammatory hate speech, medical disinformation, defamation or an aspect of pornography.  Gambling for money should be in a similar category to these and discussed in a similar context.

Recommendations:

  1. The Federal Government should recognise that the Gambling Industry and its power is the reason that Australia has a worse Gambling problem than almost any other developed country and the the Gambling Industry has a hold on Australian politics as strong as the Gun lobby in the USA, and with a detrimental effect that could be of similar magnitude.
  2. The Federal government should take an unequivocal stand that Gambling is harmful in that it encourages poor financial decision-making which puts a strain on the whole welfare system, Federal, State and NGO.
  3. The Federal government should recognise that all forms of Gambling need to be discouraged, pubs, clubs, TAB, on-course and online and this needs to be an unequivocal campaign, similar to Quit or for the necessity for vaccination.
  4. The campaign against Gambling needs to be in schools and have both a mathematical component as part of statistics, and a more practical part looking at online Gambling, and the social institutions which encourage Gambling.
  5. The campaign against Gambling must involve electronic media advertising bans on TV and all advertising and sponsorship.  It must involve active ads against Gambling as well as merely bans on pro-Gambling ads.  It should use satire and be prolonged.
  6. The control of online Gambling should be seen in the context of minimising the harm of the ubiquitous internet, and research on how to lessen Gambling should be pursued with endeavours to lessen other social harms such as child sexual exploitation, bullying, vaccine disinformation, tobacco and vaping advertising and disinformation, hate speech, video games that promote violence and defamation.
  7. The Federal government should fund Gambling research so that the social consequences can be quantified and rational decisions made about the cost-benefit to society.  Gambling research should not be neglected, limited, financed and controlled by the Gambling Industry as is currently the case.
  8. There must be support for people who have a gambling problem. Such services need to be publicised, and destigmatised, as happened for those with mental illness.  However, individual services must not be a substitute for a more systemic industry-focussed approach.
  9. There needs to be  a national register of addicted gamblers to allow better exclusion from gambling facilities. If this were comprehensive, it could be used to prevent addicts losing money online with a caveat emptor for those who took the bets from registered addicts.  The credit card companies could be recruited not to allow Gambling to such addicts and not to honour Gambling debts incurred by registered addicts.
  10. The Federal government should consider family support for addicted gamblers in the same way that child support is available for at risk families.

About the Author

Dr Arthur Chesterfield-Evans is medical doctor, who trained in surgery and became a tobacco-control advocate, then an Australian Democrat MLC in the NSW Upper House. He is currently working as a GP.

Continue Reading

The Queen and I

9 September 2022

I cannot say I ever met the Queen, or that she had a clue who I was, so if you are looking for that, read no further.

I was at the Coronation amazingly enough, as my father went to England to study surgery and I was taken to the parade and was apparently old enough to wave a flag, but not old enough to remember doing so.  (No sums please).

A friend from school, whose father was a parson and who was a very decent fellow went to London for life experience and got a lowly place at a respected PR firm.  It turned out that the PR firm did the PR for the Queen and he was attached to the small unit that did it.  His major boss was promoted to head the whole organisation and the next boss left suddenly and he, at a relatively young age became the Queen’s personal PR agent.

He was there for some years then came back to Australia, as he wanted his kids to grow up as Aussies.  He was much admired for his work there and was naturally quizzed at some length about how things worked.  He said that the Queen was very hard working and always very thoroughly briefed about everyone she was meeting, both their personal background the political or social issues that they were interested in.  He said she was astute, conscientious, kind and decent.  But she was not a Pollyanna. She was realistic about people. If they were silly, she would tacitly acknowledge this as she sought a strategy to deal with the situation.  He was very discrete about specifics and did not mention that he was rushed back to London to deal with the Royal fallout from Diana’s famous TV interview, but he did let one significant issue slip.  He was asked about the Queen’s attitude to Australia becoming a Republic. 

You may recall that a majority of Australians wanted Australia to be a Republic but they were split over whether the President should be a figurehead like a Governor-General or Queen, or whether he/she should have executive powers as in the USA.  John Howard therefore arranged that Electors were asked on 6 November 1999 whether they approved of:

A proposed law: To alter the Constitution to establish the Commonwealth of Australia as a republic with the Queen and Governor-General being replaced by a President appointed by a two-thirds majority of the members of the Commonwealth Parliament.

This naturally split those who wanted a Republic into those who wanted a President appointed by Parliament and those who wanted an elected President.  This carefully crafted split allowed the No vote to win.

The Queen apparently felt that it was inevitable that Australia should become a Republic and that it should stop silly-shallying with it and get on with it as Canada had done.  Naturally she did not say so, and my friend, who has since died would roll over in his grave if he knew that I was taking the role of a gossip columnist in writing this.

But I believe this story to be true, significant and a tribute to the Queen’s realism. 

My view is that we should have a President who is non-executive, and we need major constitutional change as to how Parliament works at the same time.  The latter half may be a hard ask.

But there is no doubt that the Republican debate is coming soon.

Continue Reading

Some Thoughts for the Jobs Summit- Arthur Chesterfield-Evans

27 August 2022

Definition of unemployment
Years ago, the ABS definition of unemployment was less than 25 hours a weeks of full time work,
which was considered to be a living wage.
The world’s definition was any regular work, even 1hr per week. The Australian definition was
changed ‘so comparisons could be made’ and unsurprisingly our unemployment rate improved
dramatically. But the figure is actually meaningless as an index of how the population’s work status
is. All gig workers on non-living wages are treated the same as full time permanent workers as the
latter category dwindles mightily.
What no one is saying is that the unemployment rate is very low because all the foreign students
and visa workers, who were getting very exploited in the gig economy, are no longer there. Even
backpackers, willing to work for poor wages as a ‘life experience’ are no longer here.
Employers have had a dream run for about 40 years. What has happened is:

  1. Australia has de-industrialised so that the organised groups of full time workers that were
    unionised and could demand a reasonable share of wages has dwindled hugely as a
    percentage of the workforce, weakening the unions.
  2. The governments, inspired by neo-liberal ideas of free markets, have attacked unions so that
    wages can be lowered. Wages are seen as a cost to the exclusion of their other attributes.
  3. Globalisation has made workers compete across the world, so as long as the goods produced
    are transportable or the service offered can be done remotely, many jobs can be ‘offshored’.
  4. It is easier for employers either to import goods rather than manufacture them here or to
    move services offshore.
  5. Increased labour mobility has helped:
    a. The development of Education as an export commodity has brought many students
    here, who are only allowed to work 20 hrs per week. Since they cannot live on that
    amount of money they are forced to work ‘illegal’ hours, so employers pay cash or
    low wages or both.
    b. The ‘work visas’ from developing countries has allowed tasks such as fruit picking to
    be done at exploitative labour rates as the workers do not know what they are
    entitled to. No effort seems to have been made to inform them, and they have no
    power if they were informed.
  6. The internet has enabled jobs to more casual, as recruitment is quicker and simpler, allowing
    more part-time and short-term work.
  7. ‘Labour Hire’ has meant that the rights of workers can be undermined. Because workers are
    not ‘full time’ but only get what shifts are ‘available’, they can still be ‘with the agency’ in a
    legal sense, but be given no work. If there is a workplace injury, creating a legal obligation
    to the employer in terms of wages and rehabilitation, this can be avoided or minimised. The
    person who they actually did the work for (and who was responsible for their injury) is not
    their employer- the agency may be, but even they can say that they are merely a conduit to
    a workplace who take a commission only for the hours worked.
    In economic terms, workers are now in a perfect market, so the price falls. Higher executives claim
    to be in a ‘world market’, so can take stratospheric salaries and the gap between rich and poor will
    grow. This is very bad for social cohesion, and in the subcultures of management there is a real and
    dangerous loss of contact with the world in which the employees live.

What is needed is:

  1. Government has to recognise and state that in an unregulated market, the power of
    employers will allow the continuation of the increasing inequity of the last 40 years. People
    are unwilling even to state this obvious fact.
  2. The Government needs to recognise, acknowledge and implement the idea that everyone
    should be able to participate in society. Not all jobs will make a profit, and a volunteer
    framework needs to be created for older folk and long term unemployed which gives them
    dignity and the ability to participate in society. But volunteers must not be cynically used to
    replace paid jobs; they should concentrate on doing jobs that are needed but otherwise
    might not be done. A structure of tasks and volunteer coordinators is needed, organised by
    local government and based on models such as the bush regenerators of Hunters Hill.
  3. Award wages for job categories are needed to set norms as a starting point for negotiations.
  4. Collective bargaining with general awards, and employers that want to deviate from them
    have to justify their position with appeals to a Tribunal.
  5. Support for Unions. Many workers cannot negotiate with big businesses any more than ants
    can negotiate with elephants. Bureaucratic Fair Work Commissions are needed to enforce
    rules, but there have to be people at the workplace to observe and advocate. The
    Commission cannot replace workplace membership systems.
  6. Aged Care and Disability industries need rules set with more input from residents,
    complaints mechanisms and enforcement. Self-regulation is frankly no regulation.
  7. A regulator and external enforcement is also needed in the aged and disability residential
    sector. Currently this is driven by real estate- the idea is to get people to sell their houses,
    move into overpriced units and then be ripped off, even in the supposedly not for profit
    sector. Once in there the level of care needed tends to increase, but not to be provided.
  8. A systematic assessment project for overseas qualifications is needed. In my own
    experience there are large numbers of very well qualified Koreans who have nothing
    recognised and work in very menial jobs. This is discrimination and a waste of talent.
  9. The Commonwealth Employment Service should be re-established as a Federal public
    service department. The idea that public servants do not work hard is frankly wrong and
    offensive. The private sector incentives have resulted in cream-skimming. The onerous
    ‘mutual obligations’ are punitive and just waste employers time. Centrelink does not meet
    its mutual obligation to help people. It takes up to 2 hours for them even to answer the
    phone. They are currently set up like a business that strives to minimise its costs by
    deflecting customers’ requests. A whole new philosophy is needed in job placement.
  10. Training is needed, especially in trades. Apprenticeships have been badly neglected as
    education has been seen as a commodity, and university education almost a universal right
    to gain entry to the upper middle class. TAFE, which was a very valuable training venue to
    get skills, a place where aging tradesmen could transfer their skills and a major social ladder
    for people pf all ages to better themselves, and hence a considerable driver of social equity
    has been long neglected. The Government needs to research the skills mix needed,
    subsidise places to fill those needs, and subsidise apprentices, obviously with supervision so
    that here cannot be systematic churn, which has happened with some job subsidy programs.
    This research can be done within the public service, hopefully with some links to academic
    departments that study employment needs.
  11. In terms of future industries, the government has to have policies that favour the change to
    renewable energy. An example of this is that Electric cars should be able to plug into the
    grid and buy and sell electricity on the spot market. This will make them part of the solution
    to the problem of energy storage, rather than exacerbating peak demand. It will also allow
    owners to offset their purchase costs. If there is a change of policy the jobs in this case will
    follow.
Continue Reading