Month: November 2019

Modest Expectations – Adelaide

I used to listen to his Letters from America – clever oral essays – the British gentleman reflecting on the mores of the day from his study in America. The author was Alistair Cooke, a remarkable figure in his adopted country, who wrote his observations in his weekly epistle until just before his death in 2004.

He had been in America since the early 1930s as a correspondent, but at the heart he was a film critic, and moreover mixing with the “stars”. One of the films he wrote about accepted the doomsday hypothesis of the last survivors of planetary nuclear war. The film was Stanley Kramer’s “On the Beach” adapted from an eponymous novel by a British expatriate who went under the non-de-plume, Neville Shute.

Melbourne was the chosen site for the film, and I remember being in the school quadrangle when Gregory Peck turned up with his son, presumably to enrol in the school while he made the film. I was struck by how much presence Gregory Peck had, without creating any fuss – just dad taking his son to school which, in 1958 was somewhat unusual, but I suppose my dad took me to school on my first day. In fact on reflection he did, found me being bullied by a future archdeacon and had me learn to box as a consequence.

Ava Gardner’s comment on Melbourne was cutting – she thought it a perfect place to make a film about the end of the world. After all, Melbourne pubs closed at six o’clock begetting the six o’clock swill where large glasses called “pots” were lined up to be consumed in the half-hour of grace before the doors were locked. Restaurants were sparse, and any place where you could drink required that alcohol to be bought in a brown paper bag and taken off the table if not drunk by nine o’clock. Men drank beer; women were segregated in the hotel lounge and God, it was not done to have a woman in the front bar. Women of refinement drank sherry; and Scotch whisky was the drink of the “top end of town”. Then, wine was consumed by the bohemian fringe of this apocalyptic maledom, as Ava Gardner viewed it.

In his review of the film, published in the Guardian 17 December 1959, about which Cooke is positive – “a story…as clean and unsentimental as a skull.” However, on the imagery reflecting on the future, Cooke is pessimistic. He quotes the collective wisdom of three think tanks to write:

They agree in approximate terms that nuclear war in the next decade is more likely than not. They warn us that the military decline of the United States in the short span of fifteen years has left it open to a devastating attack; that the disarmament at the United Nations and Geneva may blind the United States to the possibility that the Soviet union with a clear superiority in the arms’ race will use it to blackmail or attack its major opponent without warning. 

Neville Shute, the author, subscribed to the mutual annihilation theory rather than the above, (which seemed in accord with that of Cooke) since it mirrored the mindset of the late 1950s and 60s before the Vietnam War monopolised the headlines.

However, when Khrushchev engineered the Cuban missile crisis and failed, that was it – one episode of blackmail and the Russians withdrew to its reality. Competition with the United States in hindsight was illusory once the Americans got serious. However, it was not until Reagan called the Russians’ bluff and thus three decades later the Russian empire was in ruin.

Now we have Putin, the arch illusionist, at it again. Russia has divested itself of land, but they have been mindful that maintaining a number of satraps is important. Garrisoning countries is a costly exercise for a country with a GDP not much bigger than Australia’s. This time he wields his power by bullying his neighbours, which provides occupational therapy for his armed forces whether they be in the Ukraine or the Caucasus. Up to this time he has not manufactured a reason to march across Lithuania so that that exclave of Kaliningrad can be re-united with Mother Russia; but if he thought he could get away with it, who knows.

However, this illusion of the powerful strutting дуче also depends on his manipulation of Trump. Maybe I am only dazzled by the illusion of an image of a marionette with golden hair, on a wire, being paraded before a worldwide audience.

However, Prince Andrew was not the only person to be seen in the company of Mr Epstein – a figure who, in death, increasingly resembles The Tar Baby.

I wonder what Mr Cooke would have thought of this scenario which, in another context from the film “On the Beach”, could end up in mutual annihilation.

Another Alister – Another Time

There was another Alister, whom I admired greatly. His name was Alister Brass. “Alister” has a protean number of ways of being spelled.

Alister was the editor of the Medical Journal of Australia for a period in the mid 1980s – not only a doctor, a journalist, a war correspondent, but also a man of great innovation and integrity. He was lost prematurely to AIDS.

He did not have to adorn his ego with citations and references to his own achievements. He did not have the basic insecurity that often accompanies this display, and not to put a fine point on it, he viewed being editor as a full-time occupation, not a part-time bauble.

The Nobel laureate, Dr Barry Marshall wrote a telling piece about how Alister Brass helped him, reporting on self-administration of Helicobacter pylori to himself as part of fulfilling Koch’s postulates to prove that the bacillus caused peptic ulcer. Alister Brass had seen the original paper that Barry Marshall and Robin Warren had published in 1984 in The Lancet. Brass had encouraged Marshall to write an article for the MJA, which was duly submitted to “scrupulous referees” (Marshall’s words), who demanded a re-write and the final published article in 1985 became very influential in the recognition of Marshall and Warren’s work by a sceptical worldwide audience.

Marshall could not have been more clear about the value of Alister Brass’ role, as all great editors have, in ensuring the work, which eventually brought Marshall and Warren the Nobel Prize, was scrupulously refereed and then published. As Marshall himself concluded years later “Re-reading that paper every few years, I am impressed by how far the MJA Editor was ‘sticking his neck out’ in allowing me to publish a hypothesis as to the cause of peptic ulcer. It was a further 5 years before journals allowed the word ‘cure’ to appear in articles about duodenal ulcer, and almost a decade before mainstream United States journals could accept it as proven.”

Be that as it may, the point should be clearly made that two people who were outside the conventional medical establishment at that time (they were in Perth during the period of the research), Marshall and Warren, were nowhere near the major beneficiaries of medical research funding – Victoria or NSW.

The rush to citations as a sign of pumping out research papers has recently been criticised by the Chief Scientist, Alan Finkel. He mentions the “salami-slicing techniques” whereby, why have one paper when you could have three out of one piece of research? Then there is the multiple authorship where those who seem to be at the top-end of frequent flyer points appear on an article to which their input is negligible. I believe the citations record tallies over 5,000 authors. The emergence of a plethora of non peer-reviewed journals offering to publish articles in return for money, has just added to the proposition that “citations” are being discredited as a valid measurement of scientific worth.

Marshall and Warren were a temporary antidote to the accusation that so much of this form of research is trivial. The question remains: should the community reward funding submissions that emphasise process (of which parading a wealth of citations is one criterion and that insidious “proven track record” is another) rather than an outcome bestowing a tangible benefit on the community?

It is a pity that Alister Brass’s life was cut short, because we would not have to be reminded of the Journal’s worth by some obscure measurement. It would have been self-evident. He would clearly have made the above question irrelevant through the way he extracted the very best from authors and researchers in the same way Ingelfinger and Relman as Editors defined The New England Journal of Medicine.

A load of old cobblers

I sit and cobble at slippers and shoon, From the rise of sun to the set of moon; Cobble and cobble as best I may, Cobble all night and cobble all day.

In 1982 I invited David Owen, then at the height of his political powers, to give the address at the 50th anniversary of the Australian Institute of Political Science*.  Named in his honour, Sir Norman Cowper attended this inaugural Oration. Sir Norman had been among the founders of the Institute, although that is another story.  Dr Owen charged the Institute nothing. I was able to wrangle a first-class airfare London to Sydney return out of Qantas (in the days before business class and Irish parsimony).

These days politicians, after their retirements, have a habit of charging large amounts of money to perform while they garner a luscious pension for which we all pay. The current Treasurer, Minister Frydenberg, now aged 48, will in all probability be no exception. No need to retrain good ol’ Josh after the age of 60, except to identify the location of the amenities cabinet in whichever ambassadorship he has been awarded and later on retrained on how he stores his cash when there will be no banks left we can trust.

Politicians advocating this course for the elderly should not do so unless they are also serious about being role models, insisting on retiring on modest pensions and seeking retraining. Otherwise they could be subject to ridicule with a restive population calling for the re-introduction of the pillory.

Perhaps Abbot could resume his religious calling and be retrained as a Pentecostal minister; my favourite rent-seeker, Christopher Pyne because of his fixer obsession being retrained on reaching 60 as a paper hanger. However I jest – but if you think about it further, why not? Also, perhaps the word for this breed is “train” rather than “retrain”.

At my 70th birthday I was chirpy enough for people to exclaim that 70 was the new 50. It is seductive to believe that aphorism. However, when Frydenberg exhorts the elderly to retrain the answer is for what – and what time will be required for this mythical retraining and then, assuming anyone, anywhere would consider hiring this retrained person, one may only be able literally to work for a few years. Even though the average living age may have crept up to over 80, this increase in quantity cannot be necessarily equated to quality and ergo capacity to work.

Susan Ryan, Age Discrimination Commissioner from 2011-2016, used to bemoan the fact that there was age discrimination in Australia. Well, thank you for borrowing my pocket watch and telling me what I already know – if you’re over 40 and wanting a job, good luck. What did she do in her five years there? But then she was followed by another “retrained politician”, Dr Kay Paterson – and there is silence broken only by the chirping of crickets when the question is asked, what have you actually done to solve the problem of age discrimination for older Australians looking for work?

So what is the Frydenburg retraining all about? I worked until I was 75 years, and the only retraining I needed was to cope with my disease over my last 15 months, when I was deprived of independent living. However, with a carer for whom no government assistance was sought, I was enabled to ease into retirement. I had a few part-time “hangovers” from my previous jobs, which provided employment for another 18 months. Thus I was well into my 77th year when I finally finished.

Therefore it may be more about convincing employers of the worth of retaining the employees on, say, a contract for three to five years. On the other hand, I do not believe that the economy should be burdened with unproductive ageing staff. I can say that because – in the terms of the Italian calibration of age – I am about to pass from vecchio to anziano. 

Jokes aside, “working” and “ageing” provide a complex situation. I have had to deal with people who should have long since retired, and increasingly they had presented a hazard. It becomes a very difficult situation especially if they have accolades from their careers, which suddenly become more important to them when their livelihood and relevance are threatened.

I have one advantage. I have my marbles and I can look back over the past 20 years during which Treasury has put out a number of papers on this matter of ageing and the workforce – for what effect?

Just giving more benefits for a relatively small but vocal segment of the ageing population without the bother of setting up retraining scenarios, with only a marginal chance of success.

The “Golden Age” index is touted as a benchmark, but the index age range is 55-64. Fifty-five is a ludicrous age to retire, but was the basis of many public service plans with penalties imposed for working beyond that age. As a result, there has been the growth of so-called consultant work – doing what you were doing before, but at a higher rate of remuneration to top up that indexed pension, and stimulating the rise of the rent-seeker class.

Minister Frydenberg, can I hand you the last?

The Victorian TAFE sector says it takes a year to train to become a cobbler aka shoemaker. Another way of being the life and sole of the party when and if you get to 70!

*Now the Australian Institute of Policy and Science

Jesus the Leader

Now a rather sad case of a man when a post-graduate student who, when he was a student at the US Army War College, wrote a dissertation on Jesus Christ the Leader.

He described the Jesus model of leadership as love. His first criterion was that leaders traditionally sat at the top of the pile and issued orders, while Jesus “inverted the pyramid” and “he got down in the trenches and served the troops”. The rest of the “Jesus the Leader” dissertation proceeded from this statement.

Fast-forward 15 years and now Major General Gregg Martin faces his Jesus moment when as,

“The president of the National Defense University stepped down from his post last week following reports of an ongoing investigation into a poor command climate at the Defense Department-operated institution.

Maj. Gen. Gregg Martin officially relinquished the job last Monday…the move was approved by Chairman of the Joint Chiefs of Staff Gen. Martin Dempsey… Gen. Martin said he believed this was the right time for a new leader to guide the institution as NDU continued to prepare leaders for the challenges facing the U.S. Military.  

Martin was reported as having unilaterally ordered a series of sweeping structural changes at NDU without consulting its tenured faculty and other academic leaders, and that he threatened to fire anyone who challenged his plans. Martin responded that he was indeed seeking “transformational” change within the university, but that his comments were misinterpreted.”

Hardly a sign of mutual affection, but as Martin had written in his dissertation, “Jesus religiously took time away by himself, plug into his eternal power source – God’s Word – and recharge his battery. When things get extremely hectic, it may be time to consider taking an afternoon to play golf.”

Jesus thanks you for that advice. Some people may define the golf links as a wilderness but I think,

General, you are advising the wrong chap.

Jesus is the Palestinian chap on the right hand side.

In turn, Martin has languished in his own Pentagon wilderness for the past five years.

Mouse Whisper

Chevron ran an advertisement bemoaning the fact the United States reserves of natural gas were small compared to Russia, Iran and Qatar. In fact the United States and Turkmenistan vie for fourth place. This ranking has not interfered with the fact that the United States is the largest producer of natural gas ahead of Russia.

On contemplating this Chevron advertisement where ostensibly the message is that the USA has a smaller supply of one commodity than “shock horror” Russia and Iran, it struck my murine mind that how it was playing upon the fragile ego of the American people. Trump has also exploited the same fragility in his “Make America Great” mantra. Augmenting it with red dew drops of “Russia with Love” has led Trump supporters to wear T-shirts which say “I’d rather be Russian than Democrat”. You mean better be Stalin than Roosevelt?   I am really now mus confusus. People so insecure in themselves that they would compromise their country’s security. Maybe they should have a portrait of Benedict Arnold on their T-shirt as well.

Benedict Arnold

 

 

 

 

 

What Trump supporters are wearing this Fall.

Modest Expectations – Qin Shi Huang

So Donald had gone to the Walter Reed Hospital, the betting given his track record is that he may have been stented and sent back to the White House where there is probably the equivalent of a coronary care unit on site; but not in sight. It was recorded that a year ago his coronary artery calcium had been rising and was indexed at 133, which puts him the range of risking a heart attack within 3-5 years. But with a man who is so addicted to the sunny side of his street, we can only speculate about this particular episode. But from afar he does not appear well, a point I mentioned in my blog on 17 May this year.

Ironic that this news would come in the same week that that the Kooyong Papillon has been fluttering about retraining us elderly to avoid the poubelle of old age.

More about that next week, but really are we surprised?

An Apologia of Academics

In response to my comment on the creation of exotic names for senior positions, a former academic drew my attention to another university, which has gone for the Latin dictionary.

This particular university has appointed scientia professors, presumably on the basis that scientia being the Latin word for knowledge, those without that appellation are sine scientia – or in the vulgate of the Quad, dumbo professors.

Earlier in the year, the Royal Australasian College of Physicians wasted everybody’s time with a series of motions put to an Extraordinary General Meeting to form a cohort of what were to be called ‘Respected Fellows”.

One young female Fellow stood up and asked whether passage of this motion to set up this exclusive group would mean that all those who did not gain entry to the RF club were not respected. Same logic as the above comment about “scientia”.

Although this was a unsubtle way of interfering with the democratic processes by setting up a junta, it was soundly defeated. At least the College gave its Fellows the choice of whether they wanted this nonsense.

What is it all about? Is it only vanity? As I indicated in my comment in the last blog, I think this title escalation is a ridiculous affectation, and affectation is always a perfect subject for satire.

At the heart of all this titular mumbo-jumbo, it is probably about privilege – and privilege in this world of ours is one getting somewhere because one has been inducted into such an elite. It is very seductive to be enticed onto a ladder of privilege where ultimately the reward is the laurel accolade of smugness. Probably in about 400 CE, one would have found that there were a number of laurel wreaths strewn among the ruins of Rome.

Impartiality – the silent partner in Democracy

I have never met the Speaker of the House of Representatives, Tony Smith. When you read his curriculum vitae, he has all the characteristics of the modern politician growing up through a variety of politicians’ offices before being rewarded with a safe seat, which he plodded through in his initial years. However, he became Speaker of the House of Representatives after the demise of the unfortunate Bronwyn Bishop.

I knew Bill Snedden very well and one of his wishes was that after his speakership, which lasted from 1976 to 1983, the speaker, once elected to the role, would be immune from challenge in the House and generally challenge at the election. Snedden was concerned that the Speaker role be seen as even-handed, and having witnessed one of Whitlam’s crueller acts – the public humiliation of Jim Cope, which led to his resignation as Speaker, Snedden was determined to advocate some protection for the position.

When he resigned after the defeat of Fraser Government in 1983, he regretted that he had not another term to pursue the reform, yet he followed his own dictum that the Speaker on resignation as Speaker should exit Parliament immediately. He said inter alia “…under the Westminster convention, when the Speaker leaves the chair he leaves the House. I think this is right. This Westminster practice has been firmly in place all this century and considerations of which I have spoken have led to its acceptance. I have weighed this principle against other considerations, both political and personal. I have concluded that the Westminster practice is correct and, pursuant to it, I intend to leave the Parliament and will resign forthwith.”

Needless to say his wish did not come to pass and the Speakers have come and gone until Tony Smith was elected in the wake of Bronwyn Bishop’s disastrous stewardship. The Speaker’s standing as an impartial chair was severely compromised by her antics, and only compounded by Gillard’s previous ill-advised manipulation to have Peter Slipper installed as Speaker.

The Speaker’s role needs a person with a firm grip on the rules, but also common sense and a sense of humour and above all a person who exhibits impartiality.

One of Whitlam’s less desirable acts was his lack of defence of the then Speaker, Jim Cope. Cope’s “crime” was naming a Minister, Clyde Cameron. Whitlam failed to support him and Cope immediately resigned, barely holding back his tears. Later Cameron realized the gravity of what he had instigated and apologised to Jim Cope.

However, although Cope was visibly distressed, when the time came to elect his replacement and Giles, a Liberal party member was selected by the Opposition to contest the ballot against Labor’s choice, Gordon Scholes, a voice was heard clearly calling out in the House “How do you spell Giles?” It was Jim Cope. His sense of humour never deserted him.

Jim Cope was a good Speaker with only a hint of partiality.

Moving onwards to Tony Smith, Smith’s conduct in the House has been so impeccable that at the last election, he was elected unopposed, and in fact his nomination was seconded by the Member for Caldwell, a Labor MP who glowed as she seconded his nomination.

That is an important first step, but although it would be impossible to know definitely, his performance as Speaker has kept control of the proceedings so that mostly the feet are out of the gutter and if not he has ensured that they are lifted back onto the pavement. That is his immense value to Australia at a time when there is much partisan hatred in the air.

He does not attend the Liberal Party Room, which even Snedden did on occasions. That is another step towards achieving what Snedden fervently wished. Smith is loathe to use his casting vote. I have not read whether he subscribes to Denison’s rule laid down by that Speaker of the House of Commons.

Then he does not seem to flaunt the not inconsiderable perks of office, and while Snedden was the last speaker to dress in full regalia, Smith’s gravitas proceeds without having to dress up to emphasise this.

The main drawback to an independent speaker underneath all the constitutional bluster is that, unlike the British situation where one seat more or less doesn’t matter generally, in Australia each seat is at a premium. However, having looked at Smith’s seat of Casey, it is buffered by two Liberal-held seats where the suburbs bordering on his electorate if redistributed into his electorate (as probably will happen eventually )would be unlikely to change it from being a Liberal seat. Therefore, Smith is in a safe seat and unlikely to be defeated any time soon, which buys time if the notion of an impartial Speaker immune from political challenge is seen as a necessity for Australian democracy to be maintained.

I fear that installing a partisan clown in the Chair may be one tipping point for civil unrest.

I may overstate the point, but one cannot underestimate Tony Smith’s role in sustaining our democracy.

Yet the resulting conundrum of the unchallenged member is that it would effectively disenfranchise the voters in his electorate. It would be interesting to ask them whether they would pay the price for having such a person as the Speaker as their Member.

The Media & Private Health Insurance 

Guest blogger:  Terry Stubberfield FRACP*

Sometimes you just have to say something and not just grumble into your breakfast cereal about the latest media commentary.

Thus this response was prompted by Ross Gittin’s recent article in the Sydney Morning Herald (30.10.19) – “Funds cling on for dear half-life” – complete with image of grasping skeletal X-ray hand. This article made a number of claims without any supporting data.  

Gittins stated that patients are experiencing “huge out of pocket costs that they were not expecting”. Yet at the same time it is interesting to note that in the June 2019 quarter report from the Australian Prudential Regulatory Agency (APRA) the average out of pocket cost per service/episode for private hospital care for the quarter was reported as $314.51, compared with the cost for the June 2018 quarter of $308.73.

For consultant physicians 86.8% of medical services in the Private Hospitals attracted no Private Health Insurance (PHI) payment; by comparison, if you look back three years to June 2016, it was 85.3%. In other words more patients are paying no gap.  Furthermore, that payment for a consultant physician/specialist service was no more than $25, irrespective of how funded. Consultant physicians indeed having the lowest gap payment, of any medical group, if calculated as a percentage of the service cost, i.e. 1%.

In discussing the cost of the private health insurance industry Ross Gittins has concentrated on medical services. Reviewing the June 2019 quarter data provided by APRA the total funds paid by PHI during that quarter for selected areas were:

  • Medical Services $603m  
  • Accommodation and Nursing $2,789m
  • Prosthesis $543m#
  • Dental $697m
  • Optical $204m 
  • Physiotherapy $112m 
  • Chiropractic $77m.

The summary of the June 2019 quarter data presented by APRA states: “medical benefits paid per service … does not mean medical services overall decreased or increased in cost”. 

So medical services are just one piece of the puzzle.

Ross Gittins’ article simply jumps on the populist wagon where over-paid specialist doctors are the cause of the PHI sector’s woes when the data above raises serious questions about escalating costs elsewhere in the health system.

Mr Gittins also falls victim to the common error of lumping all medical specialists under one umbrella when there are multiple specialist groups: consultant physicians and consultant paediatricians for instance are those medical specialists whose expertise is predominantly cognitive; they manage the most complex conditions often for the life of the patient – adult and paediatric – on referral from general practitioners and other specialists. This referral system is one of the strengths of Australia’s health care system.

The APRA report doesn’t comment on “medical specialists” as if they are homogenous group, but appropriately deals with the different medical specialties separately.

In a speech given by Peter Kolhagen, APRA’s Senior Manager, Policy Development, to the Health Insurance Summit 2019, he questioned the health insurance funds for their tardy response to the impact of a range of issues and changes the delivery of health care in Australia – including regulatory and health demands. APRA appears to not single out medical specialists as the root cause of all the problems for private health insurance in Australia.

Gittins however uses surgery as a proxy for all medical specialists, which reflects his basic lack of understanding. Hence his final thought bubble in the Sydney Morning Herald article claims medical specialists are promoting private over public hospital care in order to line their pockets and that if there was not a private hospital system, “…they’d (specialists) do far more of their operations in the public system, probably doing more operations in total than they did before (to counter the huge drop in their incomes)”.

This is disturbing, simplistic and displays little understanding of the delivery of hospital care in Australia. The resources required to provide additional inpatient services to replace the current private hospital services, would be considerable,

Just add the annual recurring expenditure currently provided to private hospital care, (according to PHI data, of around $15 billion),

Then add the cost of infrastructure required and additional nursing and hospital medical staff required to provide much of the day to day health assessment, organisation and implementation of care.

Analysis of health care in Australia is a useful exercise, given that health care represents a significant proportion of government expenditure. However, Australians should not be inflicted with simplistic commentary that can only result in misleading the readers who rely on commentators like Gittins to give them useful and accurate information.

# A real growth increase of >10% in the past decade and I thank Stephen Duckett from the Grattan Institute for this information – and a matter which is obviously concerning enough for the Government to launch a separate inquiry into this increase in the cost of prostheses.

*Dr Terry Stubberfield is a consultant paediatrician practising in a regional Victorian city. He is President-elect of the Australian Association of Consultant Physicians.

A Royal Wave through a Crack in the Door

The door ajar; the recognisable face; the smile; the object of the smile a young lady with long hair, her face concealed; the furtive but practised royal wave; the door shuts; the young lady gone. New York wakes for another day.

I wondered where Prince Andrew Albert Christian Edward had been. I cannot remember in fact seeing him on television, except during his matrimonial tussles and briefly as a Falkland War hero.

In discussing his relationship with the “unbecoming” Mr Epstein, HRH made mention of the fact that he does not sweat.

Of course, he does not, HRH perspire. Would anybody question that fact?

However that is trivialising the seriousness of the claim.

However, on that note, HRH has suggested he does not sweat because he got an overdose of adrenalin during the Falkland War. Nearly forty years later, he says that the after effects persist. Did I hear that learned gentleman at the back of the room clear his throat and was that clang another’s jaw drop? It is known that the use of other drugs such opioids can be a cause of reduced sweating, but for how long?

It is a rare condition and because of his claim it cannot be readily attributable to a congenital affliction, especially as Dad and Brother Charles are shown often perspiring freely after a chukka or two.

However his anhydrosis claim could be tested very readily, if there was enough interest in pursuing HRH.

Otherwise, Your RH, the RAF Salmon Boars are prepared to recognise your outstanding claim with a special flyover.

In fact, the interview may be the start of another crack in the house of Windsor; it recovered from the last crisis – but then the Queen was twenty-years younger – and the potential consequences are not just airbrushing away a case of serial adultery as was the case with the Diana tragedy.

Broken is the crown …

However, this not just one indulged ageing man, who disputes whether he sweats or not on the basis of a highly unlikely reason, a figure of derision, a butt for satire, but a serious challenge to the integrity of society. If guilty, then he is a high profile child trafficker. Exploitation of children is as unacceptable as slavery. That other Elizabeth queen was deeply involved in the slave trade, but there is no record of her ever regretting it. No; she did not among her many achievements invent Teflon.

Just different times; different climes, the apologists murmur. Just poor Andrew Albert Christian Edward. This episode is mere fluff on the shoulder of humankind. No it is not!

Slavery may have been the legacy of the First Elizabethan Age; it would be a pity if trafficking in children is the legacy of the Second.

Mouse Whisper

The derivation of the term for a member of the British Conservative Party comes from the Irish “tóraidhe”, (pronounced tawra) referring to a bandit. Ultimately the root verb for “tóraidhe” implies “pursuit”, hence outlaw or bandit.

In the late 17th century Whigs were those who did not want James, Duke of York, to succeed Charles II, as he was Catholic. The Duke’s sympathisers became known as Tories, and the Duke was briefly James 11, until the powers that be did a reverse brexit – more a bradit and invited the Dutch House of Orange to juice up the monarchy.

Brexit Boris the Brigand is a real alliterative tongue-roller – but Bradit Boris has a distinctive dissonance.

In the absence of a photo of Boris the Brigand, here is Boris the pirate

Modest expectations – “JH” Taylor 326

Did you pause on the 11th hour of the 11th day of November to remember?

If you did not, perhaps a line or two from Wilfrid Owen:

What passing-bells for these who die as cattle?

— Only the monstrous anger of the guns.

Only the stuttering rifles’ rapid rattle

Can patter out their hasty orisons.

No mockeries now for them; no prayers nor bells;

Nor any voice of mourning save the choirs, —

The shrill, demented choirs of wailing shells;

And bugles calling for them from sad shires.

 

What candles may be held to speed them all?

Not in the hands of boys, but in their eyes

Shall shine the holy glimmers of goodbyes.

The pallor of girls’ brows shall be their pall;

Their flowers the tenderness of patient minds,

And each slow dusk a drawing-down of blinds. 

We have not learnt have we; just forgotten?

Another Homage

The following is an unabridged reprint in part of a NYT article. I don’t normally do this but the story is so telling:

T.J. Abraham is a block of a man with a tree-trunk neck and a lantern jaw. He played football at a top Catholic high school outside Pittsburgh and then travelled downtown to Duquesne University, where he played another three years.

He was an offensive lineman back then, and he gloried in the fraternity of hit and get hit, joyfully clanking helmets. Sometimes he saw stars, sometimes he puked and so what? Get back up and get back in. “I probably got my bell rung 70 times,” he said Sunday with a crooked smile.

He always knew he would get on with life. He was a top student, and in time he became an obstetrics & gynaecology doctor, delivering so many babies, maybe 3,000, a gregarious guy who remembered birthdays and who could make a nervous expectant mother grin. He had a beautiful home and a wife and a young daughter and a teenage son. He was a son of western Pennsylvania and life was grand.

He shakes his head: Until it wasn’t.

It was about seven years ago that the now 42-year-old Abraham said he began to notice his temper flaring without reason. His memory and judgement became flickering lamps. In a panic, he began a medical trek that ended with an inconceivable diagnosis: neurodegenerative dementia.

 When I was about the same age, I had a serious car accident, which involved a wet night, my car aquaplaning on a country road, sliding up a muddy path and hitting a pole and bouncing into a dairy, as I was afterwards told. The car subsequently burst into flames, but somehow I was able to release the seat belt and scramble out of the car. I do remember standing, laughing uproariously while the sound of the oncoming ambulance was ringing in my ears. Then everything went blank until I woke up in the operating theatre.

In relation to my head, I had a severe enough head injury without internal bleeding. However, the space between the skull bone and covering galeal aponeurosis was spongy with fluid, presumably blood although to my knowledge it was never tapped. In other words, decelerating from 100 kms per hour to zero in less than a second caused a significant head injury. In my youth I had sustained head knocks playing sport, you could not avoid it if you boxed, as I did throughout school.

However, as Dr Abraham had said, having repeated head on collisions at about 50 kilometre per hour cannot be good for the brain irrespective of whether you have a helmet or not (galea as the Romans would call it). Being medical practitioners, he and I are acutely aware of changes in our mental ability; that is until we have lost the ability to be aware.

After the accident when my various injuries had healed, I made the decision without any consultation with anybody to return to work. Needless to say it was premature; I was tolerated but many later said that I was weirder then usual and obviously I had not recovered. However, unlike Dr Abraham I was on an upward spiral and at least among my peers returned to an acceptable “normal”.

I respect him greatly for admitting to his downward spiral. I hope it is arrested. I keep looking for evidence of the mental consequences of my accident; I have the evidence of the physical legacy from the accident, but my blog is my sentinel of mental decay.

However, with these equally old men vying for public office in the United States, do they get their mental abilities tested regularly? To what extent do these old men have the honesty portrayed by Dr Abraham? If Trump’s twitters are his substitute for a blog, then the content would worry me if I was an American voter – especially if one has been unfortunate enough to be able to trace the course of fronto-temporal dementia in others as I have.

If in fact we are to countenance age in itself as not being a bar to election, it does not help on the other hand when others blinded by the allure of power are not prepared to face the fact that mental deterioration may be occurring in one of its own grandees.

Thank you, Dr Abraham for being my inspiration. I wish you all the best, and that you somehow will be able to slow the process.

Justin Trudeau lives

Justin Trudeau in a season of seeming conservative supremacy retained power in Canada in the October election, albeit with a minority government. This time, he was delayed in announcing his cabinet until 20 November. He has taken a collective deep breath. After all, he lost every riding in Alberta and Saskatchewan.

Meanwhile back at the hand-wringing barn, as reported:

It’s true that the caucus was unified behind the idea that the party’s membership, not its elected members, should hold the leader to account. But that was where consensus ended. The meeting didn’t last seven hours because MPs were lauding the leader and his team.

Always the sign that the Conservative party leader, in this case Andrew Scheer, the member for Regina Qu’Appelle in Saskatchewan, is under extreme threat. The report goes on: 

There are very real concerns among MPs from Ontario in particular, that the party will be reduced to a rump in Canada’s largest province, if major changes are not introduced…

The loss of Milton, an Ontario riding formerly held by Lisa Raitt (Deputy Opposition Leader), is seen as a harbinger by (Conservative) MPs with commuter belt constituencies who have seen their vote share dip in successive elections since 2011.

It seems that the situation is the reverse of Australia. Here the Australian Labor Party (ALP) has released a review which, despite the verbiage, seems to be an exercise of exorcising itself of Bill Shorten. The Conservatives have not yet done that in Canada.

Queensland is to Labor as Alberta and Saskatchewan are to Trudeau. At least the ALP has seats in Queensland; Trudeau does not have a riding in either of those two provinces – no seats out of 48.

Trudeau also lost out to the Bloc Québécois in Quebec. Added to his woes, Jody Wilson-Raybould, the Minister who resigned from Trudeau’s cabinet in protest against what she believed to be a cover-up engineered by Trudeau, retained her seat in Vancouver. She is a formidable native Canadian woman lawyer, with a very strong public profile.

Trudeau thus did not get it all his own way, and he literally also got a few black marks during his campaign. However despite all, his party ended up with the most seats, and he knows that the New Democratic Party (24 seats) and the Greens (possibly 4) will support him on most issues – enough for a comfortable working majority. Both these Parties have strong climate change agendas.

On the other hand the far-right party, the agenda of which would certainly have been attractive to some in the current Australian Liberal party, fared appallingly, even though the leader had held a seat in the previous Parliament, which he lost in 2019.

What is interesting is the comment about the loss of the suburban commuter vote, which is the product of a more educated electorate and which presumably will not lessen. Given there is evidence of that same shift in voting patterns occurring in the Trumpian America, this is an interesting development that the ALP should examine. For instance, the only two seats that showed a swing towards the ALP in Queensland, which virtually guaranteed Morrison’s victory, were in Brisbane and Ryan, affluent Liberal Party urban strongholds, presumably the equivalent of the “commuter vote.”

The Canadian electoral system is far different from Australia; it is non-compulsory and first past the post, traditionally thought to favour the conservative vote – but I wonder whether that would still hold true. The Canadian Senate is a far different construct from the one here in Australia. In addition, the provinces do not have the powers of the Australian States. And of course, Canada is bilingual with a strong French influence, not only in Quebec but also in parts of Ontario and the Maritime provinces.

If I were Albanese I would at least being saying “hello” to Trudeau. How Trudeau is selecting his Cabinet, due to be released on 20 November, as I noted above, would be a good topic to break the ice – which will soon be forming on the Rideau Canal in Ottawa. Come skating with me, dear Albo. 

The Expert Prophesises

I found a scrap of paper, which had drifted across my desk. Dated 26 October 2016 it was written for The Australian by Robert Gottliebsen.

It starts with a definite conclusion: “Barring some totally unforeseen event, Hilary Clinton will be the 45th President of the United States.”

Then it analyses some of her policies, which if successful “may lead her to be re-elected for a second time”. How far has the world drifted from this Gottliebsen opinion piece, some may then say.

Therefore why bother reading on. As for the journalist he has to write another piece. He may hope that 13-day lag period between the 26 October piece being published and Trump’s election will be enough time for his readership to forget. He has no time to contemplate whether there was a sliver of usefulness when his first sentence is such an almighty gaffe. He probably hopes his readership would forget it.

Yet three years on it is worth reading. Gottliebsen suggests that Clinton would have concentrated on making small business work, because that is where she saw job creation – not in big business, which should be taxed more. Her policies were directed to more prompt payment by government to assure cash flow and to make to easier to operate, unlike Australia’s “bizarre anti-small business public servants (who) go out of their way to prevent small enterprises starting by blocking them getting an ABN”.

In enhancing her agenda, Gottliebsen suggested that small business would have gained a share of what he describes as “an infrastructure bonanza”. This involvement of small business provided Gottliebsen with the opportunity to state that the “Australian Competition and Consumer Commission to recognise modern-day ‘cartels’ excluding efficient small enterprises are run by unions in collaboration with their big company mates who, in turn, pay unions big sums for favourable treatment.”

The stimulus to small business by Clinton was designed to lift the minimum wage and pay other ancillary benefits, particularly health benefits – and also increase the workforce by immigration given the pool of refugees in which to dip.

What rings so true are these comments made at a time when Turnbull was resisting the Banking Royal Commission and before bodgie building construction, with widespread flammable cladding, was revealed.

It is not that those – let us not say top of town – just say those who congregate in the spring racing carnival marquees are solely to blame, but Gottliebsen was harsh about Australian business conditions, describing the alliance of big business and the unions as “blatant job-destroying corruption”.

If this is so, then what are politicians doing mingling with this mob, and moreover taking plush jobs on retirement from the same mob when the hurdy-gurdy stops playing? You rarely see these ex-politicians wandering along the streets of their erstwhile electorates asking what they can do for these people who may run small businesses, now these ‘exes’ have time on their hands and a large pension in their bank accounts. After all, small business was always good for a photo-opportunity in the electoral cycle when the politician wanted their vote.

Now what do you call a collection of lobbyists? Perhaps a trough.

Just because the prophecy was wrong does not mean the points being made by Robert Gottliebsen an age ago are not worth a little contemplation.

In fact, Thomas Phillipon, in a recently published book confirms a great deal of what Gottliebsen foresaw – at least in America. Domination by Amazon, Apple and Microsoft; fewer airlines; consolidation of hospital and pharmacy chains – all big business conglomerates at the expense of small business. And without appropriate legislation, the conglomerates swiftly become cartels -and Australia has many examples of this.

The Citation

Nicholas Talley is a man of many parts. He was the first person I came across designated “laureate professor”. I had known about the “poet laureate” and the “Nobel laureate” designations, all derived from the ancient tradition of placing a laurel/bay leaf garland on the deserving skull. But a laureate professor, what a vision!

Universities are good at diving into the Latin dictionary and coming up with flash words like “emeritus” for those who have retired and are off the payrolls. However, the emergence of retiring women academics has meant an increasing number of “emerita”, and those of us sub salis are known as “alumnus” or “alumna” – a mixed collection of whom traditionally would take the male plural “alumni”. A neuter variety would be known as an “alumnum” but the neuter plural “alumna” could be confused with the female singular.

Now universities are bestowing “laureate’’ on their deserving staff.

In any event should, in terms of consistency, these people of high office be called “laureatus” and “laureata”?

Added to the complexity is that “trees” in Latin are generally of the second declension, where most of the words are masculine, but trees although with male suffixes have the feminine gender.

And of course we come to the word bacca – which is attached to laureate also. Everybody knows presumably that they are graduating as a “laurel berry”.

The problem is that “laureate” is getting a bit common – how about Trabea professors – no worry about gender here.

Thus, hail Laureate Professor Nicholas Talley for introducing me to this topic – especially given his expertise in citations, he would know what a Trabea is. 

Mouse Whisper 

Wikipedia summarised it as well as anybody – up to a point:

The 1894 Open Championship was the 34th Open Championship, held 11–12 June at Royal St George’s Golf Club in Sandwich, England. J.H. Taylor won the Championship by five strokes from runner-up Douglas Rolland. This was the first Open Championship held outside Scotland.

 This was the first of five championships spread over three decades that Turner won, and in line with this blog number this first was the 34th Open. His 72-round total of 326 was the highest ever recorded to win the Open – and by five strokes!

By contrast on the same course in 1993, Greg Norman won with the lowest-ever score at that time of 267, since bettered by Hendrik Stenson with a 264 at Royal Troon in 2016.

There weren’t many horseless carriages around in 1894 either, but plenty of mashies, brassies and cleeks.

Modest Expectations – The Spine

In an advertisement for the MD Anderson Cancer Center in a 2009 issue of Harper’s, a healthy triathlete smiles. His name is Bill Crews and under his name is the word “lymphoma” with a red line through the word. It is five years since he had been diagnosed and now following “an individual treatment plan”, he was in remission attested to which was completion of 14 triathlons at that point.

To celebrate his achievement a Bill Crews Remission Run was organised annually to provide funding for this Houston- based Cancer Center. Then there is a brief note in 2014 to say the website advertising the run is “inactive”. There is no record of Bill Crews dying – just that one word “inactive”.

It got me thinking, since my closest male friend also succumbed to lymphoma some years ago, although his course between diagnosis and death was far shorter. Once you get cancer, except for some skin cancers, you know your life will be limited. We all will die, but there is no need to face it until the doctor across the desk signals your mortality. You can of course avoid this confrontation by suiciding, being murdered, killed in an accident or sacrificed deliberately by those who would wage war.

What if I responded to the doctor after the sentencing: “I want you to tell me the exact day I am going to die.” What would be the response?

“Unfair question. Impossible to know.”

“OK, then will it be next week, week after… and this year, next year, sometime, never?”

We can be very precise with the input when we are provided with an individual treatment plan. Therefore, if you can give me such a plan, then it is reasonable to know the outcome, or what to expect. After all, infallibility is a power that some health professionals like to assume – well doctor, how long will I live? But then nobody writes on a funeral notice – he lasted x time longer than the doctors predicted or that the doctor got it so horribly wrong, he died well before the predicted date – perhaps in the middle of some surgical procedure, where the euphemism for “surgical vanity” is “heroic”.

The problem is that what I have written above is so foreign to how society is ordered. Most of us try and live in a predictable world. We expect that if we go to the gym in the morning it will be open at a certain hour. We know that lunch follows breakfast and we have a mid-morning coffee break.

Bill Crews probably had such a regimen. Cancer came; cancer went; but it never does. It marks time. How much of that time was consumed by unpleasant morbidity; how much did life become unbearable; and in the end, how much did he wish to live – all unanswerable now.

In fact, we live in a world of uncertainty. The flow of information from so many portals means that life is like traversing an Arabian souk. We never know what will happen next, but we always have the option of wanting or not wanting to know what we have bought – without it being varnished with fakery.

What does that all mean? Government, despite the various inputs, has to make the most cost effective allocation of resources in the face of all the individual treatment plans. There is no incentive for those manufacturing, distributing and prescribing the various medications to be less than optimistic. The cost of development of a drug is always stated as being so expensive so that the end product mirrors this expenditure. However, in the World of Optimism, who is going to undertake the rationing on behalf of community affordability. The plea, the crowd funding, the picture of the cancer sufferer, the hoped for remission mistaken for cure are all part of the emotional appeal. However, what price does one pay for a small addition to life of variable quality – what is an average of six months worth?

Policy should not be predicated on the outliers. Bill Crews had non-Hodgkins lymphoma. Through all the obfuscation surrounding survival rates, maybe his ten-year survival rate was about average when the last mention of Bill Crews was made.

Therefore, assessing the cost of Bill Crews’ treatment may be a useful indication of the individual cost for the condition. That statistic is just as important as knowing the relative success of the individual management plan and generalising from that one example.

But my whole case is predicated on two assumptions: the first is that the lack of mention of the poster boy by MC Anderson Cancer Center (now also with a red slash through the word “Cancer”) public relations, and the inactivity of the Remission Run from 2013 onwards means that Bill Crews is now cycling on a higher plane. In line with MD Anderson Center publications, I have not mentioned the word “death”.

The second is what Bill Crews’ individual management plan cost when everything was tallied, its figure would be useful enough to be used as a guide to cost – assuming that those costs could be found and adjusted for current prices.

Hopefully the responses, outraged or not by such reductionism, would be a welter of data trying to disprove my assumption. However, that could lead to a good controversy if the policy makers were listening, and cost could be determined with all the accompanying arguments laid out. Then tell the taxpayers!

The Senile Trail

Listening to the Health Minister, he talks about “self stigma” and that we should reach out for help. Well, may I tell you, if you bother to listen, Minister, self-stigma is a meaningless term, when you are crying spontaneously for no reason, when your body is at a point where you cannot undertake the activities you were once able to do; and you are alone. You reach out for what? The phone lines are always busy in the daytime. Trying reaching out at 3am in the morning wherever you are for help. About all that is left is the late night / early morning radio programs that provide an outlet to the old, the sick, the lonely who can’t sleep and who communicate with fellow callers from across the state or the country, through the radio: “How is Beryl from Cooma, we haven’t heard her on the show for quite a while, does anyone know?”

There is a great deal of breast-beating going on, because despite all the expense spent on input, nobody has a solution to care of the aged. I have been associated with nursing homes that work well, because there is a continuity in management and the constant positive is that those in charge worry and care for their nursing home community.

Being dependent implies that I have a carer, which fortunately I have “in spades”. I can no longer live independently unable to have shower, cook, dress and generally manage any housework efficiently – without help. It is frustrating knowing that when you are dependent, you have to wait – you have to learn patience without surrendering yourself to outright submission.

However, being in a wheelchair and then suddenly left facing a blank wall in an airport adds another dimension. The person responsible who leaves you without saying anything just adds that element of being ignored. It is no longer just waiting, you are being ignored and that adds a new reality. It is a sign that you a bit of garbage to be swept when the mood takes the handler. In the end, you lose your self-respect unless dementia beats you to that realisation.

Such are elements of growing old – such are the elements of being in care, where the rules are such that you – the resident – are governed by regulations engineered by government bureaucrats far away from your bedside. They call it compliance or accreditation – a meaningless term to indicate everything is under control. Unless you have a family, whether natural or manufactured, to act as the antidote, then every day is one day nearer to death, and increasingly you wish that day will come. Those words like “accreditation” have a meaning to those who love making paperwork look like an illuminated manuscript.

Are there any solutions beyond having a caring carer not an impersonal person – a shift worker with an inadequate handover when they come on duty, their measly remuneration ultimately dependent on some distant hedge fund?

All solutions are just a variation on that fact of individual care without the negative embellishment.

For instance, I mentioned in a previous blog the series shown on the ABC where four year olds visited an aged care facility over a seven-week period. Then the series finished, with an elaborate farewell antic. I wrote in my blog* at the time:

However, if the attempt of mixing the groups is just voyeuristic – “been there; done that”; then I believe the makers of this series have probably done a disservice to all involved if nothing further eventuates.

Old age is an increasing societal challenge. It should not be just a case of waste management. Yet I fear that is happening – and David Attenborough-like explorations of human foibles and cuteness should not replace serious consideration of what can be done.

The clue is in the series – get the elderly to tell their stories, whether they have a four year old audience or not. After all, it gives you a sense of relevance, even when you may be the only one listening. However even one child listening and responding with questions is a bonus. After all, I believe we are all storytellers.

My argument was not against the idea; my concern was it being generalised – the implication being that infant schools be co-located with nursing homes, so there is ongoing integration of experience – not just a one-off “gooey-eyed” curiosity but as part of a conscious government policy.

After all, each group’s experiences are transitory – the children grow up hopefully socialised to understand what it is to be old; and one of the aged care participants died between filming and release of the documentary. Such is life, as Mr Kelly is reported to have said.

It was ironic when the aged care report was released recently there was no mention of the documentary as one remedy – even seemingly by the ABC.

* Modest Expectations – Duckworth 30/8/19

Mount Augustus

 Uluru has been closed at last. To me, there has never been any question. The traditional owners should have the right to invite strangers to climb this extraordinary monolith. I have walked around the base which is measured at 10.6 kilometres and to me it felt ‘right”. Being a “whitefella” does not exclude you from being in touch with this extraordinary country. One of the things I have learnt from my association with the Aboriginal people is to know when the Land is accepting your presence.

The idea that climbing the Rock is akin to climbing a cathedral may satisfy some people as an excuse. However, the analogy does not hold. Tourists are like ants on the roofs and spires of famous cathedrals and churches; and prohibition to climb churches is more related to safety or privacy rather than it being a spiritual taboo.

The bogan chant of why can’t I go anywhere because this is Australia and I am Australian is OK if you are a self-absorbed narcissist who does not believe that any restrictions apply to yourself. There is a high-falutin’ word for this – “libertarian” and a more macho term – “individual”, its anthem: “I am what I am”.

Well, Mount Augustus may be just what you are looking for, to express your feeling and being what you are. Mount Augustus is technically a monocline but then for you guys, it is a “humongous Rock”. It is not red and bald like Uluru – it is covered by bush and it is still called by the “whitefella” name rather than its Wadjari name of Burringurrah.

Burringurrah / Mount Augustus

However, it is the largest rock in the world and I went there 20 years ago; so it exists and has not shifted. It is a bit inconvenient being 500 kilometres inland from Carnarvon. Uluru is tiny compared to Burringurrah. There is an eponymous Aboriginal settlement close to the monocline.

Rather than walking around the base, we were carted around the 43 kilometres in a minivan at a hair-raising speed by a male nurse then living in the outstation. The trip ended back near the settlement, when the van hit a large pothole and lost its wheel. Fortunately the sand provided a cushion and we were all uninjured and trudged back to the settlement. It just emphasised how huge this Rock is.

Currently, the local Wadjari people allow visitors to climb Burringurrah but unlike Uluru, there is scrub and a trail, which takes around five hours to climb and return.

Watch this space! I remember when Uluru was Ayers Rock and was hard to get there.

Burringurrah speedway

Sydney Ferries Fiasco – A form of naval gazing

Guest Blogger: Neil Baird#

It could be said that the only thing keeping the New South Wales Liberal/National Coalition state government in power is the even greater incompetence of the State Opposition. If the latest controversy over the renewal of the Sydney Ferries fleet is any indication, the Gladys Berejiklian led coalition is certainly not an exponent of open government. The Opposition has only now awakened to an announcement that was made nine months ago in February.

Unusually, the announcement about Sydney’s ferry renewal was made from Liberal Party headquarters and not from the Minister for Transport’s office. Sure, the party was in election mode but what were they doing issuing a press release announcing a $1.3 billion project in such an underhand way? What was the government trying to conceal? Why will just 13 comparatively simple and small ferries cost $ 1.3 billion? That figure appears grossly excessive. Or does that include running and maintenance costs for nine years as mentioned in one report? Why would the government not be more transparent?

Given their other shenanigans with the Northern Beaches and Mona Vale hospital projects, for example, taxpayers have every right to be suspicious. For the record, the three larger ferries are to be built in Indonesia, presumably by Penguin Marine; the 10 smaller ones are being built by Jianglong in Zhuhai, China. The local firms mentioned below Ross Roberts/Harwood Marine were never invited to tender. Nor was anyone else apparently.

It has since been fully revealed, in an 23 October 2019 press release from Opposition Leader, Jodi McKay, that the fleet replacement was a “done deal” by 27 February 2019 when the Liberal Party announcement was made.

The story goes that in early February this year a couple of Australia’s leading ferry builders had been approached with a vague invitation to tender for the ferries. Apparently they didn’t respond to the approach. So did at least one leading firm of naval architects. None could be bothered to respond as they had such bad previous experience in dealing with Sydney Ferries, apart from being very busy anyway.

The subject went quiet for a few months and has only now been revived by Ms McKay who seems to have confused the facts.

Simply put, after endless problems, mainly with the maritime union, the operations, but not the ownership, of Sydney Ferries has not officially been privatised. It is a public-private arrangement, which avoids the need to go out to tender. The French-owned transport conglomerate, Transdev have contracted to operate the ferries, and seem to have eliminated most of the problems when it was run by the NSW Government.

Yet the curious way the ferries were ordered remains, with virtual concealment of the nature and cost of project from the taxpayers of NSW.

While Ms McKay has revealed some of facts, other parts of the story are off-beam. While the Trade Unions have been one of the major reasons for the problems at Sydney Ferries, the relative absence of shipbuilders in NSW has not helped.

However, she is partly correct. The ferries could have been built locally, as she advocates, but the only company in the NSW with experience in building ferries of the size ordered is Harwood Marine of Yamba in Northern NSW.

Strangely, Harwood was not even approached or invited to tender. Indeed, the managing director of Harwood was unaware of the government’s intentions until very recently. Harwood has been busy with a major expansion of its company’s facilities including, ironically, a 60 metre shed in which large aluminium ferries could be built. Equally ironically, those who could have benefitted – the local youth workforce in a town where unemployment stands at 23 per cent – didn’t get a look in.

Apart from Transdev, which is expected to correct Sydney Ferries’ inadequacies, one major local firm will benefit from the association with Transdev. That is the Port Macquarie-based company, Birdon, which moreover has been contracted to build ferries in China and Indonesia for Transdev.

Birdon is a highly reputable company, as is Transdev. This fiasco is no reflection on either. The government may well get a good deal in the end. However, the problem is the opaque process that the government followed. The State Opposition has been unaware of such a major project, until the belated statement from Ms McKay. It is also a major problem that Harwood, a significant employer and highly reputable local shipbuilder was not even asked to express interest in the project.

The taxpayers of New South Wales have not been well served by its politicians.

We have not heard the end of this.

# Neil Baird is non-executive Chairman of Baird Maritime, a global maritime trade publisher. Among his other positions, Neil is a long-serving director of the Australian Shipbuilders Association.

Mouse Whisper

Once I heard the confession of a poker-faced mouse whisperer despite it being difficult to squeeze into a murine confessional box.

“In January 2004, I was in grade 12 of high school and about to graduate. I operated a profitable web design business as a part time job for some spending money. Seeing as my legal name is Mike Rowe, I created the domain MikeRoweSoft.com for my portfolio. The Canadian lawyers of Microsoft didn’t like this (I really don’t know how they found my site, I had 2 visitors a day. One was me (sic), one was my mom). They sent me a couple of emails and a large legal document telling me to give up my domain name. I asked for $10k. They said no. I went to the media. Hilarity ensued.

Since then I’ve been a full time professional poker player for the last 3 years. I’ve made enough to buy a condo and live very comfortably in that time. I have finished 5th in the PokerStars Sunday Million for $97,500 as well as 31st at the PokerStars Caribbean Adventure earlier this year for $40,000. So I guess you can ask about the poker stuff as well if anyone wants to.

And no, I didn’t sell out for an XBox.”

The site was still active in 2017, but not now.

Modest Expectations Skat

“The problem with the drought is that it is predominantly affecting National Party electorates and as the Prime Minister charges round these electorates all he succeeds in doing is emphasising the impotency of government, while making the National Party look like drongos. Then enter off right, the Belgian fixative who does a deal with Hansen who knows when to throw a tantrum. Obviously her colleague in Tasmania has viewed this Flemish reflex, which has been adapted from Pavlov’s observation on canine behaviour. Frankly, I am sick of Keating’s unrepresentative swill being given a disproportionate voice while I struggle to pay my mortgage and make ends meet, all because of the manipulation by a Flem.”

Unfair; of course. But that is one example of how Australia is perceived as being governed. Maximising the influence of a few to the detriment of the majority. Just the frustration of being a young urban graduate, and collectively primed to burst forth, when the articulate leader of reform – perhaps a numerate “Whitlam” would help – emerges in the next three years, a person who puts the interests of the country first. Or do we reach a Chilean tipping point where the rules become radically different.

Some weeks ago, I recounted briefly that I had just come back from Chile where I made a point of visiting the Museum of Memories and Human Rights. At the time I said that the museum was “the brainchild of President Michelle Bachelet, to ensure that one memory sticks in the mind of the Chilean people. On a wall on the first floor are myriad photographs of Chileans murdered by the Pinochet regime – 130,000, probably more.”

Recently, she has visited Australia in her role as the UN Commissioner on Human Rights to deliver the Whitlam Lecture, which was booked out by the time I got round to it. But from snippets, I got the gist.

I had also seen an enticing advertisement for a house nestled in a valley between Santiago and Valparaiso – separate terraced complex houses a sauna, Jacuzzi and hot tub, and two bathrooms. The property also includes a one-bedroom guesthouse, a covered parking area for four cars and organic orchards with 750 avocado trees and other fruit trees with “income-producing potential”; on 17 acres handy to both Santiago and Valparaiso. The price? About AUD2m. All this under the headline: “Following a tax hike and a steep drop in sales, prices are rebounding thanks to a stable economy and new infrastructure projects.”

Yes, when we had been in Santiago in late August, it had seemed very quiet; well run city, taxi driver even praised the cops as the only honest police force in South America. However, that contrasted with a comment in The Economist about the current President, Sebastián Piñera, which concerned the social conflicts with students that had bedevilled his first term. In order to reinforce the point, The Economist alleged police had tried to cover up their murder of a member of the Mapuche, an indigenous people.

The Economist added, “That followed a string of scandals – ranging from planting evidence to corruption – in the Carabineros, the once-revered police force. The army is no better. Some officers have been found to have stolen public money; others have sold arms to drug-traffickers.”

Somewhat different perspective from that of our driver as we drove through quiet suburban streets to the Museum …

Sure, when we later went on the road to Valparaiso, the slums stretched along it for miles inducing a feeling of unease.

On the way, stopping for a wine tasting in the Casablanca Valley, it was just what you would expect from a wine tasting vineyard in Australia – impeccable surroundings both inside and out, a fire to warm this predominantly young stylish crowd from the winter cold. I was reassured there that Chile was an exemplar of middle class respectability.

Then off to Valparaiso, where the poor in barrios cling onto the sides of the steep hills, yet all with a stunning view of the ocean. Here the streets plunge down these steep slopes – a variation on the big dipper. Barrios did not exude stark poverty but the people in the doorways or struggling up the streets with their provisions did not look happy.

It’s not that long since Valparaiso was almost destroyed in a massive earthquake, and the city has a shabbiness that belies the fact that it is a tourist centre and the politicians meet here in the National Congress building. The city had a sullen feeling, despite it being one of those places where there is so much intrinsic beauty, at least to my eye, despite its vulnerability to earthquakes.

Now two months on, the cities are aflame, the streets are crowded with a rioting populace, the army has been called out. The 130,000 dead on Bachelet’s Memorial wall have had a few added.

The cause? A seemingly minor increase in subway fares has proved the tipping point. The people have had enough. The country’s prosperity revealed has been heavily weighted to a small fraction of the community who can afford to buy the property described earlier.

The currency is devaluing, the inequity in everything from wages to health care lies revealed. The hatred of politicians has boiled over; despite conciliatory gestures. People lie in the streets, dead or injured. Tear gas lingers; property estimated to be worth $2 billion Australian dollars has been destroyed in the rioting, and the number arrested harks back to Pinochet’s times. The military are on the streets, their punitive powers on show. Piñera has cancelled two international conferences presumably not to show the World his intention to return to a military dictatorship.

After all, he has an approval rating of 14 per cent, presumably by all those hiding within gated communities. Piñera is reputed to be the wealthiest man in Chile, having introduced credit cards into that country and, as a badge of his mercantilist mind, he has manipulated stock such that he faced court more than once. He is the sort of person, who fits in with the definition of “politician”. He is a man well versed in fraud who has tried to shuffle his Ministers, but the protests have increased. Shuffling or sleight of hand generally also means taking money from someone else’s pocket.

Those in the streets are not fooled. They can see what awaits them on the horizon. All they have to do is go in the Museum and see the filmed images the morning Chilean democracy last died on 11 September 1973.

Bubble Australia

The Congress in Valparaiso has been invaded, and while the major excuse given for the increasing development of Parliament House into an impregnable Bubble Australia, thought must have been given to a popular invasion to construct it in such a manner. Presumably Bubble Australia has food and cocktails in store to last for six months in the event of a siege.

When people hate politicians enough, the tipping point will be reached. We are not immune from a Chilean-like situation – the only difference is that Australia has yet to have experienced a Pinochet. Yet we have a number of very good would-be impersonators.

I think Chile needs you back, Michelle. As for Australia, the space is unfilled – as yet. But then one of the characteristics of these new movements, apart from their youth is the difficulty in finding the leader to be carted off to gaol, effectively decapitating the rebellion. The Extinction crowd is on the streets, but they do not have the same mentality as the police force in its armour plate; and one has to hope wearily not to have a rerun of Queensland brutality à la Springbok tour or ageing commentators of both genders mimicking Askin’s admonition to drive over curly-headed young Sri Lankans – metaphorically of course.

However, if a society is unequal in its rewards system, and in their Morrisonian Bubble the beneficiaries try to insulate themselves, eventually someone will prick the Bubble or let the air be exhausted from the Bubble. It may take time, but there will come a time if there is no remedial action, we could end up like Chile or, for that matter, Hong Kong or Beirut.

Another Play with Words

Guest Blogger – Chris Brook*

The NSW government has announced that it is moving away from activity based funding in health care, to an outcomes-based funding approach. More recently the Australian Treasurer has declared that he wants Australia to do likewise to a quality care approach and eliminate low value and unnecessary care.

Both reflect the adoption of a new approach to measurement of value.

This announcement presages the latest fashion in health care economics and organisational design in the United States, which is value-based health care.

It is growing into a huge industry reaping enormous fees for consultants. As with any scheme, it gains keen audiences for its promoters because of its purported benefits and simplicity.

Basically the theory is simple – along the lines of:

(a) value, never quite defined but clearly related to outcomes and

(b) value, again never quite defined but including elimination of low value or unnecessary care resulting in:

  • integrated care
  • improved efficiency at all levels
  • team based care
  • patient-focussed care
  • higher quality care
  • better outcomes
  • improved prevention of ill heath and
  • lower cost

How could anyone object to such a set of targets?

And this all happens, apparently, through tweaking of economic signals along with better IT, better data capture and use, incentives for provider re-organisation and a value focus by patients. No wonder funders love the idea, or at least the components they choose to understand. However, like all things that sound too good to be true, it is too good to be true.

Some of the issues emerging are:

  • it is a North American solution to a North American problem
  • it assumes complete market flexibility, both patient and provider
  • it does not define outcome (clinical, functional, meeting expectations – actual against expected) and
  • it does not define value (whose or which value particularly)

Nonetheless some very interesting tools are being developed, such as much better prediction software which may dramatically alter future risk rating down as far as the individual level (with all the accompanying risks that entails).

To give the topic due attention needs at least a podcast discussion, with more than one opinion to assess.

This is but a teaser – an opening shot.

It does remind me that the world thought it had the solution to health care back in the 1930s, with the establishment of health maintenance organisations with uncannily similar promises – and promise!

As a very smart man once said to me looking into the mirror: “Chris, health maintenance organisations are a great idea and always will be.”

*Chris Brook PSM FRACP is a medical practitioner with 30 years senior management experience in the Australian health system

Tiempo, damas y cabelleros por favor

I came across the 29 May 2009 issue of Time which listed the 100 most influential people in the World. These lists are just one form of vanity press, a filler where high profile people are paid to write about other perceived high profile people who, unlike the writers, have attained the “magic” hundred.

The first one listed was Teddy Kennedy, who promptly died before the end of the year – and his legacy was his work in advocating for still unfinished health care reform. The second one listed was Gordon Brown, his paean written sympathetically by J.K. Rowling. He is long gone from the influential hundred; although he is probably behind the scenes within the Scottish resistance to Brexit.

However, in the 100 influential figures listed, both Boris Johnson and Elizabeth Warren get prominent space. A young Boris Johnson with boyish face and laughing eyes is eulogised by Conrad Black. One might say that it takes one to know one, but Black, ten years on pardoned by Trump for his malfeasance, was right in saying that Boris was a man to watch.

For her part, Elizabeth Warren is there for her expert knowledge of bankruptcy through all its shades, and her take on the financial services industry; she is “characteristically unfazed by the criticism.”

Surprisingly Putin and unsurprisingly Trump are not listed, and Xi Jinping is reduced to a narrow column on page 28. After being described in his role then as the Chinese vice-premier as “best known to many Chinese for his singing wife”, the writer goes on to pen that Xi lost his patience at a meeting in Mexico. He is quoted as saying, “Some foreigners can’t seem to mind their own business and sit around complaining about China.” But as the writer went on “He carefully flavoured the complaint as a joke, which took some of the pressure out. The politician’s instinct, it seems, is always at the ready.”

And as the writer said earlier in his piece: “the running joke in Beijing is that anytime there is a potentially nasty task, Xi gets it.”

First, Xi may joke, but he is no joke, and secondly I am not sure how he would describe Trump, but he obviously has a great deal of experience in such matters.

As for the rest, well there are those in elected office, those blazing a trail as “influential” and in the end there is mostly a Warholian outcome – maybe a tick over 15 minutes.

All shook up …

Guest Blogger:  Janine Sargeant*

Hard to believe, but there apparently are “Elvis Loathers” – designated by areas of calm cobalt blue on a demographic map of the USA. The “Elvis Lovers” are bright red and shake up much of the eastern half of the US.

Like him or loathe him, Elvis is everywhere

This map appeared in the August 1993 issue of American Demographics. Prepared by a Texas market research firm, using demographic data and addresses of members of Elvis fan clubs, it purports to show the depth and breadth of Elvis fandom. The most “Elvis-friendly” places apparently are small towns dominated by mills, farms and main street retailers, but also the newer blue-collar baby boomer suburbs on the edges of cities like Atlanta, Miami, Austin, Kansas City and San Diego.

Bob Lunn, then president of Direct Image Concepts Inc., said he launched the Elvis survey for a client wanting to sell Elvis memorabilia. While the client went bankrupt, Lunn’s company enjoyed plenty of publicity by making the survey available to the media. The 7,000 responses to his questionnaires came from Elvis fan club members. He used the responses to develop a composite of the then typical Elvis fan: a conservative, blue-collar, white woman in her 40s or 50s who votes Republican, has a high school education or less, is married with children, watches sitcoms and the Home Shopping Network and reads Bride’s Magazine and the National Enquirer. The typical fan also drives American sedans or pickup trucks, swims in above-ground pools, smokes menthol cigarettes, drinks malt liquor, and eats white bread, canned meats and Velveeta – all of which probably had a place on Elvis’s pantry shelves.

The Elvis map showed the clear divides that commonly exist in the US between east and west and north and south, although in this instance the north eastern states (with the exception of New York and Boston) certainly carried the flag for Elvis.

However, the map demonstrates how data can mislead. Based on Lunn’s methodology Alaska, with the exception of Anchorage, apparently is full of Elvis Loathers. Problem is, not much population in Alaska to move that state into the red zone (or perhaps it is just that the moose prefered Little Richard). Look more closely at the blue zones (except perhaps Blue Hawaii) and to a large degree the problem is a lack of individuals to sign up with an Elvis fan club.

What would the map show if it were redone now? Probably a lot more of “Elvis Who?” in beige, although it would likely now be called “Elvis? Meh.”

Exercises like these are an amusing diversion, but perhaps not to be relied on, as Lunn’s client discovered.

Janine Sargeant runs a medical association in the not-for-profit sector.

Mouse Whisper

Funny coincidence but my mouse trainer’s thirty-second wedding anniversary has fallen in the week of the thirty-second Modest Expectation blog. A coincidence, but in the world of gifts even for such an anniversary, ebony is the go.

Ebony mouse whispering