July 2019 - The Best Mouse Tap

Modest expectations – Pale Waves

One thing I seem to have missed as I have aged is the music revolution. Last week in Melbourne there were all these people in red dancing around in a park – something to do with Kate Bush, in red, outside a window singing about “Wuthering Heights”. My appreciation of music is limited by the fact that in its creation, playing and singing I am completely talentless. However, I understand that there is a very popular band called Pale Waves, an Indie-band with a lead singer called Heather who has one of the voices that would divide a mosh pit like the Red Sea. They sing:

I was eighteen when I met you

Poured my heart out, spilt all my truth

I finally felt like I could feel for the first time

When I met you.

The video is dark and moody with more than a hint of sex but with all the “on the road” clichés pasted along its way.

Now my era danced to Chuck Berry’s “Sweet little Sixteen” – bit of poetic licence in the age difference, but it is all about being young, which is the root of nostalgia. The Beach Boys pinched the tune for “Surfin’ USA”.

Sweet Little Sixteen

She’s just got to have

About half a million

Framed autographs

Her wallet’s filled with pictures

She gets ’em one by one

She gets so excited

Watch her look at her run

Berry was a genius. The singer from Indie Pop group, Pale Waves may turn out to be one as well. I saw Chuck Berry perform in the twilight of his career in a basement in St Louis. We were the ageing mosh pit; it was one of our most memorable experiences.

I missed the Pale Waves when they were here in 2018, but perhaps they will roll in again.

Fanfare for the Common Man

I am not an American citizen, however for what it is worth, I have an alternative view of the USA to that of its President.

I have friends in Lubec, on the Canadian border in Maine. Across the water in Canada is Campobello Island, which is synonymous with Franklin Delano Roosevelt. Roosevelt smiled; he exuded optimism. He was also a cripple, struck down by the poliovirus one morning on this most beautiful of islands. Yet he strove for his own independence and courage.

I come from a country where to bare arms is to get down to work with my fellow citizens. I have never seen a gun except sleeping in a rack. Maybe I am careful, but the myths of the NRA are powerful, like those of Washington Irving. The story goes … it’s the guns that kill, not people. Guns must therefore awake, get off the rack, stretch their barrels, and discharge a thousand bullets before breakfast. People are killed but guns remain the same.

I live a country where there is no gun culture comparable to that of the United States and yet our major commemoration is a World War One disaster at Gallipoli and our national day is called by some “Invasion Day,” when Great Britain dumped a bunch of their unwanted – convicts and marines – in a desolate place called Botany Bay in 1788. Despite its apparent vigour, this is a country rooted in pessimism.

America’s national day celebrates something more than putting a British foot on a distant shore.

Australia has a dirge for a national anthem. America’s anthem was forged as the smoke from the British bombardment of Fort McHenry cleared in 1814 and the American flag was still flying. Francis Scott Key was inspired to write the words of “The Star-Spangled Banner.” Today Fort McHenry is one of only two places in the United States where the 1814 fifteen-star flag still flies. The other is at the end of the Oregon Trail.

I love my country. I have travelled all over my own country.

But then I have also been privileged to roam the United States too. I have sponsored musk oxen called Amethyst and Pixie Stix in that Folly, Alaska. I have sat in the San Franciscan courtyard and then written about the early days and aspirations of Genentech before Silicon Valley arrived to crush the city. I have eaten king salmon in Salem, Oregon, and crab in Sabine Pass, Texas – both sublime experiences. I have stood at the doors of that miracle of Minnesota, the Mayo Clinic. I have gazed at Mount Rushmore and know now why those four presidents were carved. I have wept at Shiloh. I have stood in the wheel ruts of the Oregon Trail in Douglas, Wyoming. I have joined in a march to the Tenderloin on January 15. And so on … identifying something extraordinary in all the 50 States I have visited, not to mention Puerto Rico.

However, I am white and while there was a certain exhilaration of being part of a January 15 homage to the life of Martin Luther King, I have had another far different experience of turning a corner in the national capital from a gentrified brown stone street, to find that I seemed to be the only white person in the street. Not even an Officer Krupke. I did not turn; I walked briskly making no eye contact yet experienced the tension of being alone in a very foreign country, well outside my comfort zone. I walked the block, before turning into another zone of brownstone gentrification.

I have money; I do not have to panhandle; I have a bed to go to every night. I do not have a child in a cage on the Mexican border. I know where my children and, for that matter, my grand children are.

Now, my luggage did vanish forever at Los Angeles Airport. I still had money and passport, but trying to find a suit of clothes in downtown Washington was a challenge. In the end a modified “zoot suit” made me feel very foreign.

Only once have I had to use the American health system. I quarantine myself by taking out very expensive travel insurance. I am able to do so. My actual experience with the health system came one day after I had run in the Annual Bay to Breakers fun run in San Francisco, a novel way to see that city. I developed a dental abscess, but as I had to fly to Orlando taking a day to get there with only aspirin and bicillin which did nothing. Hence when I arrived late into Orlando, I experienced probably my worst night in pain. I sat up all night watching the wrestling on TV and in the morning the organiser of the conference, seeing that I had a face the shape of an angry balloon, took me to an endodontist who immediately drained the abscess without requiring me losing any teeth. I had immediate relief from the pain.

The United States in all its diversity, both good and bad, has been my energiser from the first time I went there. But I am and have been a privileged observer able to see the sights and yet travelling around its less well-known parts without a gun being poked in my face.

Even in adversity, America has always exuded optimism, and on my latest visit it was no different. But that was almost two years ago.

Make America great again!

What crap!

America remains Great despite all its warts. The only problem is that the USA has a President who wants to make America Hate.

He wants Americans to lose their Smile, to lose their Optimism; to lose the meaning of the fourth of July.

Such a pity!

Twenty years has passed

Let me start with a quote:

“… there is no substitute for a careful and painstaking history and a meticulous physical examination. This is the cornerstone of medical practice…”

This came from a 1977 article by Lou Ariotti – it is clear; it is not infested with jargon. It says it all. It is applicable across all health practice.

Lou Ariotti was the real deal in Charleville for many years and some of what he did with limited resources was remarkable. Initially, there were no beds in the hospital. So he taught the families how to look after the sick in the home, taught them simple procedures. There were inadequate facilities at the hospital; so he set up the forerunner of the day surgery in his premises.

However, very tellingly he stated that he got his inspiration from the Mayo Brothers who trekked out from Chicago as young medical graduates into the Minnesota wilderness – and today we have the Mayo Clinic.

What the Mayos demonstrated was that you can move intellectual capital to remote areas, but you have to have succession planning. As I have said many times, the doctor in the bush faces inter alia social dislocation and professional isolation.

Yet that world of the Mayo Brothers and Lou Ariotti was the world of the individual. The difference between the Mayos and Lou was that the Mayos left a legacy and Lou Ariotti a memory. Lou made sure the Queensland Premier provided him with a large hospital, but as you know monuments are just that. He may have admired the Mayo Brothers, and while he left an adequate health service – his legacy was the memory of himself, the man rather than memory of Charleville itself being a centre of medical excellence.

After all, we are still digging up parts of the ruins of ancient Roman monuments, but the Vatican on the same site as Ancient Rome has learned the trick about matching monument retention to succession planning.

This was written last year for the commemoration of the first 20 years of the Mount Isa University Department of Rural Health, part of the successful endeavour to move the education of medical and other allied professionals to universities of rural health and rural clinical schools. In my last blog, I questioned the glacial progress of the review of the MBS. Having been closely involved in the introduction of the rural clinical schools, it is disappointing to read that the Rural Health Commissioner, in a recent article, can only conclude by saying “a nationalist rural generalist pathway is good for rural communities” Appointed two years ago in 2017, it has taken him two years to say that! Oh, I forget, there are the inevitable diagrams.

But at least he will have a huge number of happy snaps to remember where he went over the past two years as the rural Bill Peach.

Seriously are these reviews going anywhere? Now there is talk of the Health Minister ordering a heath of private health insurance review. Hopefully, Minister, the deadline will be somewhat tighter than the ongoing ones. Show the community how they are influencing health policy or are they just an elaborate way of doing nothing while re-arranging the flowerpots on the window sill?

Mouse Whisper

I remember when the song “Diana” was released in 1957, and the sensational fact at the time was that Paul Anka was the 15 year old song writer as well as the singer.

The story goes that Diana was an older kid who used to look after Paul when he was a child. Paul had a kiddy-crush on her with less than enthusiastic response on her part. There was about a three-year difference. Years later, after the song went to Numero Uno on the charts and he was a star, she suddenly showed up saying, “Take me! I’m yours!” to which he gently replied, “Sorry, our time is past.”

But she still had Diana!

Modest expectations – Chlorine

I am indebted to Stephen Zifcak and the Menadue blog for this quote:

“If I were a journalist, these and other related developments cumulatively would be causing me very considerable alarm. Recently, in response, the Alliance for Journalists’ Freedom has produced a report on the state of press freedom in Australia (Press Freedom in Australia, White Paper, May 2019). It describes the progressive erosion of that freedom. The report argues for the enactment of a Media Freedom Act. The purpose of the Act would be to enshrine the principle of press freedom in law.

The Act would recognise the fundamental importance of national security and the protection of the Commonwealth’s intelligence and law enforcement activity while providing for the fundamental right of journalists to investigate and report on government corruption, surveillance and misconduct in public office. The report’s recommendations are not without legal difficulties. Nevertheless, it provides a sound starting point for a debate that goes to the heart of the Australian democracy.”

I would have thought that this is a call for the media in the jargon of today to weaponise itself. The head of this Alliance is Peter Greste, and as the face of the caring yet resolute person, there is none better.

The Alliance has a Chief Executive Officer who has been recently appointed. Olivia Pirie-Williams has a record as an activist and her poems reflect her deep affection for our planet. Her first target in January this year was the release of the two Burmese journalists employed by Reuters, Wa Lone and Kyaw Soe Oo. They were released from prison in May.

The Alliance seems to have powerful friends and as such should consider running candidates at the next federal elections, targeting electorates in South Australia, Victoria and New South Wales. They are the potential spine of a centrist party, where the various freedoms of speech and association are protected; and where the enemy is defined as the trump-sucking, authoritarian, rent-seeking mercantilist.

The problem with the Independent is that they have no future. They can stay around a long time like Andrew Wilkie, but unless the seat is turned into a dynastic satrap as the Katter family has made Kennedy, he will eventually become a footnote in history, a nameplate on a wall in the Royal Hobart hospital.

The way the seat of Indi has been “transferred” indicates that succession planning for Independents is possible and what has been done in Indi may be a blue print. Catherine McGowan may be the centrist required for setting up such a party.

In the end the problem is that Independents are generally rounded up. The least line of surrender coupled with seduction of the perks of office means joining the party most likely to retain the electorate, thus goes the independent back into the authoritarian fold. South Australia like Tasmania has a history of independent thought, but who remembers Steele Hall – and his legacy? Even NSW – but who remembers Ted Mack?

From my experience of journalists and politicians, their personalities are complementary – they like to tell people what to do. Press secretaries in politicians’ offices generally come from the fourth estate in a revolving door. Some go further, as Deakin, Curtin and maybe Abbott have done federally and Carr and Rann at State level.

Therefore the Alliance has the opportunity to form a centrist party, provide an umbrella for the current Independents and target vulnerable seats in the cities – and you never know. Greste has the personality honed by mental if not physical agony, where the right wing trolls would try and destroy, but I am sure he would have studied the Trumpian playbook on John McCain’s reputation.

A perfect time to review defence capital expenditure (Capex)

Neil Baird comments …

With the elimination of Chris Pyne, Australia is presented with an excellent opportunity to make a comprehensive review of our defence priorities. Pyne’s apparently more realistic successor, Senator Linda Reynolds, should grasp that opportunity.

In real terms, all the major Navy and the Air Force Capex projects have barely started and, in many cases, are decades away from completion. They could sensibly and relatively economically be paused, if not cancelled, while Australia takes a breather and re-thinks our requirements, priorities and most importantly, what we can afford.

Many of the ship, submarine, aircraft and weapon system purchases are scheduled so far into the future to be almost certainly obsolete long before their delivery date. They will undoubtedly cost a not inconsiderable $200 billion or more and be delivered years later than the already ridiculous 30 years that have been signed off by then Minister Pyne, his generals, admirals, senior bureaucrats and their American advisers.

Too many of the projects were ill-conceived for reasons more related to South Australian than National warfare. Minister Pyne may well have been a great representative of South Australia but he was wasteful of national taxpayer funds during his parliamentary career. Now, since he abandoned Parliament, apparently thinking that the Coalition Government was “a sinking ship”, he is seeking a new career as a defence industry lobbyist. That will only add insult to severe fiscal and defence readiness injury. Thus, the current orders for submarines and F35 aircraft, among others, could well be stayed if not totally scrubbed.

The nature of modern warfare and its weapon systems is changing dramatically and rapidly. The Americans are spending vast sums of money on unmanned systems for land, sea and air warfare. What Australia could learn from the Americans is more about unmanned technology, as Israel is doing; Australia should be rapidly developing its own. For example, the Boeing Aircraft Corp is developing an unmanned submarine that could well be appropriate for the shallow seas to our north. The Americans are also very advanced with the development of unmanned aircraft, including helicopters.

China has openly declared that America and Japan are its biggest worry and is continuing to battle with them. China has examined American weaknesses and is developing comparatively economical weaponry to exploit them. Ironically, the platforms for some of their best fast assault boats capable of launching long-range hypersonic cruise missiles were designed in Sydney. The Chinese (PLA) Navy has more than 100 of these vessels each carrying eight missiles. Their role is to “take out” American nuclear aircraft carriers.

By contrast, the Royal Australian Navy has none.

The Australian “Defence establishment” suffers from a considerable cultural cringe. For instance, it seems to believe that Australian designs and innovation are generally worthless. Some unkindly suggest the acquisition of frequent flyer points influences Defence purchasing decisions – but surely not!

Nevertheless much of the Defence Capex is invariably purchased offshore. It is then, too often, married incompatibly to being constructed locally. It is no wonder that local shipbuilders, except for the inefficient government-owned ASC, shun dealing with the Australian government, despite the local connection with the abovementioned Chinese missile boats.

This point is worth reiteration, because it is usually forgotten by Government. Australia is a world leader in the design and construction of very effective and efficient fast craft, including large and small patrol assault boats and fast logistics support ships.

While they had little choice, China has taken a practical “clean sheet” approach to the choices of weaponry and doctrine. Australia should follow their example, as it has its own unique cultural and geographic advantages and disadvantages, rather than blindly be following the USA and other ostensible allies. In the end Australia may be very much on its own. After all, who would USA side with if Japan were to go mad again and attack us? Japan has done it before. As far as trade is concerned, it could be argued that Japan is far more important to America than Australia is. We should prepare for all contingencies.

We could learn a lot from a closer study of China’s defence plans and practices. Its Maritime Militia should inspire Australia to look at this inexpensive option for our fishing and offshore service fleets as well as state government owned patrol boats. Unlike China, Australia has virtually no Merchant Navy and the few domestic cargo vessels Australia does have could be much more effectively integrated. The CFMMEU, of which the Maritime Union of Australia is a small but important component, should be eliminated or drastically reformed. That is the only way that local shipowners might be encouraged to invest in coastal cargo shipping which is imperative for defence.

Australia should also be very carefully re-considering our aversion to nuclear power and weaponry, but nevertheless should be developing a substantial cadre of nuclear engineers and other experts.

Australia constructs no diesel engines. As most warships, submarines, tanks and other land vehicles are diesel powered, Australia should be developing the capacity to build a wide range of them here. There is an existing global system for building diesel engines under licence to leading manufacturers. Australia should involve itself in that system as soon as possible.

Similarly, Australia refines almost no diesel and jet fuel in Australia. Most of our diesel is imported from Singapore. Australia has tiny reserves and should be encouraging industry to develop at least one diesel and jet fuel refinery in each state plus a couple more in the north.

China is also constructing much longer-range fighter-bombers than their American equivalents. They are also being fitted with long-range hypersonic cruise missiles to further extend their effectiveness. The cost of all these is dramatically less than for their American counterparts.

The effectiveness of the Russian Buk missiles recently used to down the Malaysian Airlines aircraft over the Ukraine should be heeded, despite the tragic connotation to many. Such truck-mounted weapons could be spread all round our northern coastline. They would be much cheaper to position than using ships or aircraft.

There is so much that we could do better, more logically and more economically. We should remove the focus on welfare from defence planning. The favouritism for South Australia has to go. If something can be built better in that state than elsewhere, fine, but otherwise, it should be built where Australia can obtain the best deal, not to provide jobs for redundant car workers. A fundamental thus should be that the review be a truly national project and not one that favours any one geographic region.

With the re-election of the Scott Morrison government, now is the perfect time to re-think our defence priorities. However let us “leaven” the defence establishment “experts”, its generals, admirals, air marshals and bureaucrats seasoned by academics with some practical business people, among them ship builders, naval architects, aircraft manufacturers, electronics experts, petroleum refiners.

Otherwise, Australia is doomed to repeat past mistakes. The Defence Department decision-making will continue to be slow and an ineffective, expensive millstone around our national neck. Our current purchases will inevitably be delivered so late that much of the equipment will be obsolete before it sees service. Senator Reynolds, as a senior Army Reserve officer, should be aware of the many defects of the current Defence Capex arrangements. It is up to her to ring the changes.

Neil Baird PhD is non-executive Chairman of Baird Maritime, a leading global maritime trade publisher. Neil has expert knowledge on fatal ferry accidents, their causes and how to prevent them. He is a former chairman of the World Ocean Council and the Australian Marine Environment Protection Association; a director of the Australian Shipbuilders Association; a member of the Domestic Ferry Safety Committee of INTERFERRY, the international association of ferry owners; and co-convenor of that organisation’s FerrySafe programme, sponsored by the Lloyd’s Register Foundation.

The Christie syndrome

Some may think Winston Churchill was an undischarged maverick. However, he recognised one principle of politics, for whatever else he did, he could be forgiven.

He refused to appease the tyrant.

He refused to appease Hitler. He realised that you cannot appease tyrants – especially those so self-absorbed they believe in their own infallibility. The only outcome was unconditional surrender, which Hitler helped by committing suicide. Whatever Churchill had done before in his long public and chequered career could be forgiven, given his resoluteness to stand up to Hitler. I am sure that he had all the pressure to make peace with Hitler, especially when the other appeared to have the upper hand.

Chris Christie was the hapless Republican Governor of New Jersey, who urged his way into heading the Trump transitional team. As he admits “He felt he could stay on the sidelines or support Trump, gain a seat at the table, and improve Trump’s behaviour”. Wrong – under the chuck wagon!

This situation has been repeated: appeasement – effusive praise – abusive humiliation – under the chuck wagon.

Theresa May tried to appease – dismissed.

Sir Keith Darroch trying to smooth the Trump visit to meet the Queen – a very stupid guy.

The British government has quite a record of cuddling up to dictators. For instance, Mussolini was given the Knight Grand Cross of the Order of the Bath in 1923 from King George V and, more recently, the Romanian dictator Nicolae Ceaucescu got a gong.

So much for appeasement. But the saving grace, which probably burns within the Trump brain was he was not accorded a peerage on his recent trip, or at least an Order of the Garter, given his self-confessed love of women.

Fast forward to Boris Johnson. He is already a Halifax rather than the Winston Churchill he blusters to be. He will be tossed aside unless he does exactly what Trump wants him to do – apparently destruction of the European Union with his peculiar enhancement of the Putin connection. My only parenthetic comment is that I hope to see this skein of history seared in our collective memory when all is revealed.

However, Boris first has to be crowned.

But irrespective of this outcome the British Isles are now held hostage to the Trump manipulations. Appease all you like, I fear that to get anywhere with the special relationship is to make him the Duke of Queens and betroth his son, Barron (the name says it all) to one of the junior royals in good ol’ mediaeval splendour in a new Trump Tower Cathedral opposite Buck House. Now that would be a deal.

However, seriously, just as with the Nobel Prize speculation which took off with help of Trumps’ publicity machine, wait for the quest for imperial decoration.

Meanwhile, Australia dangles on a thread of aluminum.

Mouse Whisper

Be careful if you approach a door in Portugal and someone says for you to push. That sound in Portuguese means that you actually should pull open the door. However, when you see the word, most of us would have difficulty recognising it as “push” – “puxe”.

On the other hand “quando empurra vem empurrar” – when “push comes to shove” – the Portuguese use the same word for each.

After all, the Portuguese very early gave us what should be our watchword: “Abre olhos!” Open your eyes!

The West Australians know it well as the Abrolhos.

Modest expectations – Tennessee Ernie Ford

We were having lunch at the weekend and were discussing the penalty of age and what happens when you grow old. “Yes”, he reflected. “You may have a point. Once, my phone calls were returned immediately; now it may take four days or longer.”

I immediately thought of a time I was at a function in Dubbo and a number of politicians mentioned my name in glowing terms. One guy came up to me and said he had not heard of me, but I must be influential because of the things being said about me. “No, I replied, “Influence is ephemeral – it can disappear as quickly as it appears.’’

Not that some people do not retain influence for a long time – but there is a price to pay. You have to mix with a crowd of the same types grasping at the ephemera until, like Citizen Kane, they have only “rosebud” to murmur; some don’t even have that.

The comment that summarises much of what occurs was from the defeated member of parliament who said what he noticed most was that the telephones stopped ringing. Obviously that image needs to be updated in social media terms, but it summarises the ephemeral nature of influence and the intellectual laziness that surrounds it and which is epitomised by the growth in each politician’s office of the number of consigliere.

Traditionally, the more senior the ex-pollie the more important the government sinecure away from Canberra; some ex-Ministers have became chancellors of universities all the way down the ephemeral rungs to that of teaching politics part-time. Using their retirement or ousting, some are able to undertake pro bono or voluntary work, underpinned by their generous pensions and their contacts.

The problem is that politicians over the past 40 years have become outrageously well paid, with generous perks that seem to be never-ending. However, the stories of excess are not met any more by community outrage when reported but by clamours for more of the gravy train tickets.

“Jobs for the boys” have been replaced by the scourge of “rent seeking” – essentially jobs for doing nothing while wrapped in the gossamer of influence.

The hoary excuse for such greed is “I have sacrificed so much.” To which is added the lachrymose sacrifice my family has made for my increased prancing around in the Ephemera.

To put it bluntly, a rent-seeker is just a metastasis. A cancerous excrescence away from the main tumour, but still reflecting the nature of the tumour as it destroys the framework of the body. Doing no good but draining the life from the body for a price.

Yes, a metaphor, but the metaphor is obvious. And the metastases, male and female, let’s mention no names but they know who they are.

Mr Unaipon – My modest acknowledgement of NAIDOC week

Of all the Aboriginal people, I would have most liked to have met David Unaipon.

He died when I was in my mid-twenties. I had never heard of him then.

But what had been my exposure at that time to Aboriginal people? Virtually none. I had been to the Hermansburg mission as a child and seen Albert Namatjira and Rex Batterbee, the white fella associated with encouraging Namatjira’s talent in watercolours and that of the Western Arrernte people.

I was a rabid Essendon supporter from a young age. Norm McDonald played on the half back flank for Essendon. I never thought of him being Aboriginal, a Dhauwurd Wurrung man from around Lake Condah; just a magical footballer – boy was he fast!

Then, if an Aboriginal person was mentioned with the word “footballer” it seemed always to be Doug Nicholls.

It was a world where I could have met David Unaipon but there was no $50 note to tell me he even existed.

David Unaipon died in 1967, and the closest I have got to him is his grave overlooking Lake Alexandrina, Victoria’s name before she became queen.

One of my fondest memories of when I used to go around the bush was seeing the Ngarrindjeri land near the mouth of the Murray river at Raukkan. Its Lutheran church is pictured on the $50 note. For some reason, it has some of my best memories.

One of my clearest memories of Raukkan was going into the Aboriginal office and seeing the number of portraits of their late elders lining the wall – mug shots as you would see in a whitefella boardroom. There was no concern about showing the faces or mention of the dead among the Ngarrindjeri, so I was told.

I happen to have a wonderfully annotated copy of David Unaipon’s slim volume “Native Legends” which he wrote in 1929. It is said to be the first volume actually written by an Aboriginal person. He is succinct.

For instance, Pah Kowie – The Creature cell of Life and Intelligence is just one page and concludes:

“Thus many of the ideas formulated by my ancient fathers may seem absurd to an enlightened age fantastic and absurd, but to us these ideas are the foundation of a structure and edifice of knowledge under whose shadow we live today.”

I wonder what Mr Unaipon would have said today.

However, I am a bit surprised that this early work has not been reprinted, at least as far as I know, given that most of us are reminded of him everyday.

The Bruce Robinson New World Odyssey

I remember the Independent Enquiry into the Repatriation System under the wonderfully named Justice Paul Toose. It was set up in 1971 and did not report until February 1976 – three elections and three Prime Ministers later. As people in government joked, this “plodding” inquiry lasted longer than the First World War and ran to 800 pages and 300 recommendations, one of which seems to have been changing the name of the repatriation department to the department of veteran affairs.

Not that I would like to see the Review of the Medicare Benefits Schedule break the Toose record, but Professor Robinson is giving it a red hot go. The review has been going for four years – for what? Any review that takes that amount of time becomes problematical.

As a comparison, while this Robinson Review with its 30 committees has been meandering along, the Review into Australian banking practices under Mr Justice Haynes has been [2017-2019] and reported in 1,137 pages ; in the USA the Mueller investigation has also been [2017-2019], and reported in 472 pages.

They were somewhat significant inquiries.

Yet here we have Bruce Robinson and his crew backed by McKinsey just like the Mississippi River, “it just keeps rollin’ along”. I have heard the time 2023 mentioned as the new end point. Well, that would break the record – a formidable feat. Probably we could have a plaque to celebrate the finish of this Homeric epic.

Perhaps getting a sharper Shadow Minister for Health in Chris Bowen will see if we can dam the Robinson and his multiple tributaries.

The subsidiary question is how much has McKinsey cost the Government for no noticeable impact – you know McKinsey, the firm that is in a running feud with the NYT about its methods and clients. It is an unedifying backdrop.

It is interesting that the latest round of Ministerial adjustments to the Medicare Benefits Schedule by Minister Hunt did not seem to mention the Review. As one senior politician said to me once, governments use these inquiries as a means of maintaining a freeze on patient benefits. I wonder if the patients themselves know of this stratagem.

Unlike the original Nimmo Inquiry which reported in 1969, which had the knowledgeable advice and expertise of John Deeble and Bruce Scotton, subsequent reviews since the breakdown of the periodic Enquiries conducted by Government and the AMA have not achieved very much – but at a great cost in time and the employment of outside consultants.

I should know. Medibank and Medicare have been central to the life of most doctors, including myself and it should not be left to slowly decay, because of an interminable uncertainty, which is the other side effect of an unending wander through the Medicare Benefits Schedule.

Knock before Entering

My wife loves photographing doors. Front doors, that is. Front doors opening on streets; front doors not hidden by a pathway, a garden, a porch or verandah and a flyscreen.

In it simplest form she believes the front door defines the place, the thoroughfare, the relationship of one place to another, the people behind the door in the space, working and living there.

I am not so sure. I see the front door as an identifier of the place but not necessarily those behind the door. Many of us merely inherit our front doors. Many front doors do not identify anything. There may be nothing behind that door but an empty space.

The doorway is Ianua in Latin, named for the god with two faces and from where the word “January” is derived – and janitor as well. January is the doorway to the year. We cannot prevent anybody from passing through the doorway. February always comes.

We, however, may have a janitor to maintain the upkeep of door and passageways. That person may have many names and interpretations in many languages.

We invented the door and then locks to keep people away from the space behind the door, for whatever reason. The door becomes the vehicle for the lock and for maintaining permission to use that space. The door can become a massive contraption to secure that space or as occurs in rural areas in my country just a way of keeping the dust and the animals out. The houses meanwhile are left unlocked. The unlocked door can be a measure of trust, but also a measure of carelessness.

Once I could turn the handle on any church door in any out of the way place, and I could enter and stand in this church with all its furnishings and stained glass intact. This is not carelessness, but an act of trust by those who have the key to the door.

The front door as an inanimate piece of wood or metal is an obstruction to that passage, and so may be an identifier. My wife may be right. How we regard the front door in fact may define the civilisation in which we tread.

Mouse Whisper

I decided to try my hand at shrew taming. I sent for an application form and received the following questions. Well, not actually.

I have inserted the word “shrew taming” to protect the names of the drongos who manufactured these questions. My reflection is the same as it has always been, except my fur is bit greyer and the lines on my faces are deeper than when I was a pinkie.

But see if you can interpret this set of Parts into English. Good Luck!

“Part 1: Tell us about yourself and your role

Objective: Understand the individual’s overall role and interactions with shrew taming

Part 2: Tell me about your experience with shrew tamers

Objective: to understand individuals touch points with shrew tamers and their overall end to end experience

Part 3: What is your overall reflection based on these experiences?

Objective: to understand shrew tamer’s strengths and pain points to identify future areas of focus for the end to end experience

Part 4: What would you like to see more of in future?

Objective: focus on the future experience and how we can orchestrate touch points in the future to ensure a seamless experience.”

Modest Expectations – Union

One can hardly believe that in a country with so many challenges there is so much concern over some footballer who made a list of people he wished to be assigned to Hell.

Echoing what I wrote in an earlier blog, Peter Singer, the bioethicist, is reported as having written:

“Folau is a born-again Christian, and his post was an expression of his religious beliefs. To prevent misunderstanding, I should say that I do not share those beliefs. As an unrepentant atheist, I am among those for whom, Folau believes, hell awaits. But that does not trouble me, because there is, in my view, no god, no afterlife, and no hell. Nor do I differentiate, ethically, between homosexual and heterosexual relationships.”

Singer picks up the “hell awaits”. It is not as though Folau is advocating violence or even earthly sanctions. Nevertheless, the sheer arrogance of such a list should not have goaded the Rugby Union establishment into a response, which in turn has started a chain reaction. It has enabled the fundamentalist Christian groups to start braying about religious freedom, using Folau as a martyr strung up on a goal post.

In the course of this saga the community is being suckered into a situation where a silly statement is now being adopted by those who want to use the cloak of the Christian Church to run extreme agendas; where dominance of women is one of, if not the main objective.

Symptomatic is the resurfacing of the anti-abortion crew, who have never gone away – the matter has become a surrogate for maintaining the subservient role of women. Christian churches out of the mainstream are very good at keeping women as handmaidens, where the violence is not necessarily physical. And it is not limited to Christianity.

I have a visceral dislike for abortion, but it is not my business – not my choice. It should be a woman’s choice.

There was one occasion when I was faced with a friend who wanted an abortion, and the potential father had disappeared. It was at a time before the Menhennitt ruling changed the secrecy and enabled abortions to occur openly, and the words “criminal abortions” rendered obsolete. (In Victoria, a landmark Supreme Court ruling in 1969 (‘Menhennitt ruling’) established that an abortion will be lawful if the accused held an honest belief on reasonable grounds that the abortion was both ‘necessary’ and ‘proportionate’.)

The whole episode made me so disgusted that we, in an ostensibly Christian society, were allowing women to be exposed to emotional and – on those occasions when the “backyard” procedure went wrong – physical trauma on women. Here a degrading scene was being played out, because men – predominantly men, and celibate men at that – thought it sinful.

Fortunately, my friend survived the ordeal. She recounted what had happened, I was appalled but we never talked about it again.

That is the worry if this whole Folau imbroglio, with the forthcoming legal action, is allowed to energise this group of anti-abortionist misogynists over what is, in the end, a belief lodged somewhere inside Folau’s head that should have nothing to do with anything but his contract with RU.

Nearly 20 years ago, Susan Ryan, the former senator, reminded us it had not been that long ago that the House of Representatives’ vote against abortion – four years after the Menhennitt ruling – was 98 to 23.

“The debate was conducted in an all male chamber, the women were outside rallying, organising, shouting through loud hailers, preparing for disappointment. I decided that next time we should be in there making the laws.”

It is not often that I agree with Susan Ryan, but I do on this matter – wholeheartedly. The whole of the Coalition voted against the decriminalisation of abortion although one young Liberal party member who stood up with a flourish as though he was going to break ranks and cross the floor to vote for decriminalisation, looked around and seeing he would be on his own, sat down.

As for Folau, it may have been easier to tell him to get lost. Of course he would not have, but I do hope that when some other sportsman near the end of his career and with enough notoriety to be noticed, says something as stupid as Folau has, that the situation is better handled, including not to renew the contract at some astronomical figure.

For instance, select him in an Australian team and he can then work out who is the adversary, given that he likes to compile lists.

Somewhat more important than Israel Folau

Opera is watched by an estimated a total audience of 300,000. It is a form of artistic licence that belongs to a different age. In that age women were treated dreadfully, composers had various forms of pathology. Who knows how many operas were written under the creative phase of syphilis so rife then. But now, to try and change the opera so as to satisfy a fad is as crass as the efforts of the Bowdler family in the 19^th century to change Shakespeare to remove the “dirty bits”.

It is ironic that a report in the SMH of the opera “deisembowdlerising” itself, is perched alongside a report about the number of hate and violent items appearing on Twitter, Facebook/Instagram and YouTube. Here those indulging in such unspeakable behaviour are totalled in the millions.

So while token behaviour to cauterise opera plots may make those involved feel appropriately righteous, the problem is not solved by tokenism towards women’s rights.

However there is, as reported, a public health emergency in the way social media has become diseased.

Humans coming in contact with one another harbour the means of infecting one another with both the good and the bad. Globalisation is the jazzy word that we have for the removal of barriers to the spread of a vector, be it conventional trade, disease or whatever.

As the globalisation of Christianity occurred so did the spread of European disease against which the Pacific islanders and Australian aboriginals among others had no defence.

Similarly the globalisation of those who went to the New World of the Americas took a cornucopia of transmissible diseases as the contribution of Europe in this “free trade of infection”. In return Columbus is reputed to have brought back larges doses of syphilis. So it was a form of bilateral trade.

In those days when there was no idea what caused disease: perhaps the miasma, which was great for the perfume trade; or some dark unknown medium, which provided the excuse to torch women – and the ersatz cure – the miracle sustained by intercession via prayer or veneration of some osseous part of a saint.

Perhaps it is encryption that is the best analogy, especially as the means it has to deceive is akin to microbial mutation.

However, it is always the word “plague” which focuses the mind. And while we do not have the spectre of bodies loaded on carts being wheeled to mass graves, the world is entering into a time of cyberdisease, and “cyberplague” is convenient shorthand, although it has been used in generic terms before.

We now know the bacteria Yersinia pestis causes plague. Fleas and lice carry the bacteria. They can also lodge directly on humans if sanitation is bad – otherwise rats, dogs and cats inter alia are convenient intermediate hosts.

These abbreviated instructions from the Centers for Disease Control (CDC) in Atlanta on how to prevent plague provide clues:

* Reduce rodent numbers. Make your home and outbuildings rodent-proof.

* Wear gloves if you are handling or skinning potentially infected animals to prevent contact between your skin and the plague bacteria.

* Use repellent if you think you could be exposed to fleas or lice.

* Keep fleas off your pets by applying flea control products. Do not allow dogs or cats that roam free in endemic areas to sleep on your bed.

So it should not be too difficult to assign the appropriate language to deal with Cyberplague. One thing is for sure: it is the role of Government to supervise. The private sector does not do this well.

This darkening cloud over social media is the scourge. It is a public health emergency. And Donald Trump seems able to call a National Emergency, at a drop of a red cap… if he understands.

Where did all the Money Go?

I received an email this week from John Kitzhaber, once the Governor of Oregon and the man who received international attention when he devised the Oregon Health Plan. In part he wrote:

The cost of health care in this country is utterly out of control. Mind-boggling. Approaching $3.8 trillion a year. This amount of money has attracted a whole host of private equity funds (that are) simply milking the system to feed shareholder profits. We had big national for-profit insurance companies that are likewise using public funds to increase shareholder value instead of reinvesting in the community.

John Kitzhaber – painting by Henk Pander

That problem is now also occurring here. When the Medibank model was established here in Australia, the expectation was that the patient would receive a medical benefit when they consulted a medical practitioner to assisting in paying for that medical service.

Doctors were considered to be in solo or group practice, and in fact when the first benefits were struck for procedural items, it was assumed that the benefit reflected what the government was prepared to pay to the patient for the perceived skill of the doctor.

Therefore when the array of medical benefits was struck for a surgical procedure, it was assumed the patient benefit recognised the skill of the doctor. The cost of the attendant scrub nurses, the surgical materials, the operating theatre were all absorbed into hospital costs, covered either by the public or private hospitals. In other words, the Medibank the scheme was constructed on a guild model – a hangover from the time when doctors sent accounts in guineas to patients who could afford to pay.

However, the medical professional entrepreneurs recognised that with the advance in technology, particularly in pathology but followed by diagnostic imaging with the arrival of the CT scans, there was a “pot of gold” awaiting. Radiotherapy and general practice have followed, and now other specialties such as cardiology are the target.

Technology improvements emphasised two of the problems with an open-ended floor price scheme as Medibank and subsequently Medicare demonstrated. The first one was the entrepreneurial manipulation of throughput against capacity for a particular procedure. This was lucrative when the Medicare benefit was set at a low throughput and not scrupulously adjusted over time as throughput increased with technological improvements. The second was the tiresome ‘pass-the-parcel’ game between the state and federal governments, otherwise known as ‘cost-shifting’. Private sector entrepreneurs have been able to utilise this for their financial gain but state governments have equally become adept at the cost shift and at the same time burying the real costs of health care.

As can be seen, health financing was drifting away from the original intention of enabling the patient to get a fair and reasonable subsidy for their medical care

The problem with the business model, which may have been devised first by economic rationally doctors in the Edelstein mould, is that it has been transformed into a business model not unlike the one described by Kitzhaber.

Here the doctors may be listed as the providers but in reality it is a company which employs them in some form which is harvesting the profits and shovelling Medicare money who knows where into tax havens around the world. Medicare money has acted as seeding finance for the eventual acquisition of overseas health companies.

It is difficult to watch the Federal government being so compliant. The problem is compounded by these companies giving a fraction of their Medicare-seeded profits to political parties for them to enable to run election campaigns saying they are looking after “all Australians” and thus these private firms to have a firm foothold into the political process.

The central governmental agencies know this but at present their political masters are impervious to this flow of taxpayer’s money off shore – after all we have a taxpayer Medicare levy so some firm profiting from such taxpayer funding can buy a health service in the USA or a pathology company in Germany – in effect using Australian taxpayers’ money to fund their business and not only that, but funding where there is a guaranteed floor price for each of services. So risk is negligible once the investment model is settled.

Kitzhaber’s comments are more than timely.

And for us in Australia, it gives us gives another meaning among others for a sonic boom.

Mouse Whisper

Heard between Nobby and Cambooya driving through that magnificent black soil country of the Darling Downs.

“Mate, the soil is so good out here you can plant nails and they come up crowbars.”

Yes, appropriately it is Steele Rudd country out here. But as my young mouse cousin asked “Who is Steele Rudd?”