Modest Expectations – Earthquake in Hunter Street

I arrived at the Melbourne apartment having come down from Sydney on Wednesday 25th November. The desk calendar said May. I had not been here since then?

The Virus has wreaked havoc and it is time to reflect given that I have been writing my blog continuously during this time. Hence, once written, always there.

There have been two major disasters – one was the Ruby Princess. Some say the targets to whom I assigned blame were wrong. There is always the fall guy, and people have told me who it is.

Given the Premier seems to be wrestling with disclosing her misdemeanours, she is trying to deflect an increasing number of embarrassing disclosures by filibustering. The “poor little me” melodrama is becoming increasingly tiresome, but people should listen to her fellow Armenian, Mr Aznavourian sing “She”:

She may be the face I can’t forget

A trace of pleasure or regret

May be my Treasurer

The price I have to pay.

Increasingly her NSW constituents may begin to agree with her fellow Armenian’s summation. Obviously, the Queensland Premier may agree as she has used poor Gladys as a punching bag; the State of Origin biff has extended to the two government leaders.

Anyway, the Queensland Premier has her own idiosyncrasies, apart from Jeanette Young, including her insistence on being called “Palashay” and not the original Ukrainian “Palastchuk”. Perhaps it was this Slavonic heritage that loved the sound of Dr Young’s continual “nyet”. Who would know?

Border closures were initially effective as was confining people’s movements, but after a while it became a symbol of secession – even puerile schoolyard spats. It should be noted that if Andrews had not given it credibility by supporting Morrison’s “National Cabinet”, it would have floundered. In any event Morrison has shown little trustworthiness.

Lockdown had a novelty value as Insiders showed with their amusing washing troubadours way back in March and Daniel Emmet continued the fun with his banishment of the Virus to the sound of “Nessun Dorma”.

However, it progressed from a romp when Peter Dutton came back from the USA with the Virus and it was reported that his senior colleagues immediately panicked until they were quietened down by Dr Paul Kelly. However, the lavage jolliness had given away to a sense of vulnerability, albeit fear.

What has happened is that the State governments took the matter very seriously and closed the borders. It is a difficult area to manage because not opening borders can lead to two outcomes, as has been shown over the succeeding months. The first is that despite the Commonwealth having the quarantine power it was virtually ignored by the State Governments – except in one area – the actual meaning of “pandemic”.

However, in one way, the Commonwealth listened to the health experts, and those like Brendan Murphy, who was appointed Head of the Federal Health Department, listened to the health experts in his own team – Paul Kelly and Nick Coatsworth. There were myriad others with varying levels of health expertise, but apart from a number of superficial missteps, Murphy listened to the right voices and the distilled Health advice prevailed over Murdoch and his fellow Ignorants, most of whom could understood the share market but not much else.

In the end, apart from the tourist industry and interference with social communication, the real effect of border closure was magnified by the closure of the NSW / Victorian border. One of the worst happenings is to continually go into lockdowns, then open the borders, then go into lock down again – on and on heightening confusion. I am not a fan of hotels being used as quarantine facilities because in the end all are porous. This is the nature of the beast, especially when you impose imprisonment without accompanying health expertise, and then find out you did not have the expertise anyway. This occurred in Victoria and Daniel Andrews assumed control, locked the State down, imported the contact tracing expertise from NSW, where it had saved the Armenian bacon, and while all about were behaving badly Andrews gradually, over 112 days, bullied Victoria into compliance. It was a terrible time for those in the State but demonstration of the discipline needed to eliminate the virus that is raging everywhere else in the world, apart from selected areas in the South Pacific.

In the end, the strategy had its effect. It suppressed the Virus, and in the case of Victoria probably eliminated it. As a result, woe betide any tennis player who comes to Australia with a cavalier attitude. He or she will be faced with a battle-hardened population who are not going to allow a set of “celebrities” to import the Virus. The message is plain.  Get it into your heads, nobody is going to breach security again and bring in your own tidal wave of infection.

What Andrews showed was courage under fire from the Murdoch media and an Opposition who, if their actions were seditious rather than serious criticism, should be facing charges. He showed that once a lockdown is imposed, and his State embarked on a recovery plan, he had to get it right and not backtrack. That drifting in the political breezes is happening all over the world, in and out of lockdown with political rather than the resolute application of health priorities being uppermost . Under the recklessness of the Mad Trump or the hubris of the Swede “Turnip” Tegnall, people die, people clog up the health system and, as with any arterial blockage, the end result is death to the blocked area.  Andrews showed the way by eliminating the blockage and should be overwhelmingly elected Australian of the Year.

South Australia has since had a similar outbreak in hotel quarantine, and the lockdown was far shorter and the epidemiological weapons used had been improved across Australia since March. As this blog goes to posting, NSW has just had a breach in hotel quarantine.

Underlying all the political action is that there will be a viable vaccine available soon. There seem to be plans upon plans for distribution of an untested product.

There are two questions that seem to be consumed by the cacophony of the public relations spin. What are the side effects and can I die from the cure? How long does the immunity last? You see, I grew up in a world where we had injections before we went overseas, and they did not grant life-long immunity. You had to get injected for cholera and typhoid each time you went overseas – and the latter gave me a nasty local reaction. I’d been through it at that time, bearing my vaccination card, when overseas travel was a far smaller sector than in the modern world.

This whole area is complicated by the Head of Qantas saying that you would not be able to board an aircraft unvaccinated. Forced to take an unproven vaccine? Where is the duty of care? The world of business is treading a perilous pathway.

Finally, one thing I would say is that the media is braying about how well our political leaders have stood up in the recent polls. Did the polls award Morrison the Lodge in 2019?  Did the polls accurately reflect the votes in the recent US elections. Let’s face it. Polls stink.

Ah yes, but this is the poll I like. It says I am popular. The politician preens. It says that people think of me as a perfumed gardenia. Beware, gardenias die very quickly and leave a stench not a perfume. But then I am given another gardenia, and it’s alright, isn’t it?

Why not a Summit at ShaTin?

The Chinese are insulting us. The Prime Minister armed with his Pentecostal shield fights back. The Chinese are trying to strangle our industries. The Chinese have taken over Hong Kong completely. Dissidents are being locked up.

Sha Tin race course

But it is not all bad. There is still horse racing in Hong Kong – whether at Happy Valley on the Island or Sha Tin in the New Territories with Australian-bred horses, Australian-bred trainers, Australian-bred jockeys and even Australian-bred stewards. All their antics are broadcast by Channel 7 in the interests of Sino-Australian recognition of our long association with the Hong Kong Jockey Club.

The Chair of the Club is Phillip Chen Nan-Tok. He seems to be well connected, having been a senior executive of the Swire Group and of various property developments in Hong Kong and on the Mainland.

It is all unreal. Munchkin-like barrier attendants. The race commentary and in between race commentary is all very English, although the race-caller is obviously Antipodean; he does not have the languid style of the British race-caller or the unintelligible brogue of an Irish counterpart. There he is describing Australian horses galloping around these racetracks with not a whiff of tear gas or the young rioting against Mainland repression.

The betting brings Hong Kong plenty of money – and not an Australian boycott in sight. I wonder therefore if the Chinese will be at the Australian horse sales in the New Year.

Bliss

My son gave me “Abraham Lincoln” – which coincidentally was reprinted in 1939, the year of my birth. This book was written by William Thayer, an American educator, who was born during the American Civil War.

Lincoln

The book details a mob response to the death of President Lincoln in very graphic terms:

“In some localities the grief expressed itself in the form of vengeance. It assumed that form early on Saturday morning in the city of New York. Armed men gathered in the streets threatening speedy death to disloyal citizens. Their numbers rapidly increased, until fifty thousand assembled in Wall Street Exchange, bearing aloft a portable gallows, and swearing summary vengeance upon the first rebel sympathizer who dared to speak. One thoughtless fellow remarked that ‘Lincoln ought to have been shot long ago’; and he was struck dead instantly. The grieved and vengeful crowd seethed towards the office of the World, a disloyal paper, with mutterings of violence on their lips. It seemed scarcely possible to prevent violent demonstration. A bloody scene appeared to be imminent. At that critical moment a portly man, of commanding physique and voice, appeared upon the balcony of the City Hall, from which telegrams were read to the people, and raising his right hand to invoke silence, he exclaimed, in clear and sonorous tones:-

‘Fellow-citizens, – Clouds and darkness are round about Him! His pavilion is dark waters and thick clouds of the skies! Justice and judgement are the habitation of His throne! Mercy and truth shall go before His face! Fellow-citizens! God reigns, and the government at Washington still lives!’

The effect of this serious address was magical. The raging populace subsided into repose. A hushed silence pervaded the vast assembly, when the voice of the speaker ceased, as if they had listened to a messenger from the skies. The change was marvellous. The speaker was General James A. Garfield, who became President sixteen years afterwards, and was shot by an assassin four months later! How strange that the inhabitants of that metropolis, who listened to the gifted statesman so gladly, April 14th, 1865, should be shocked by the news of his assassination on July 2nd, 1881!”

There are two stories in this excerpt from the book. The one directly showing that in times of crisis America always seems to unearth a saviour. Garfield’s ability to quell the mob reaction restored a degree of order into what was one of the most provocative acts imaginable to incite mob revenge – the assassination of Abraham Lincoln.

James Garfield had been a major-general in the Union forces while still in his 30s and had seen action in some of the major American Civil War battles such as Shiloh while still a young man. He may have been described as portly in the above excerpt, but he was only 34, and “portly” is not a word I would normally associate with a person of that age.

Garfield

Moreover, as with Lincoln, Garfield was born in a log cabin – Lincoln in Kentucky, Garfield in Ohio – both Republicans, both with progressive social agendas.

When Garfield was shot, he had a doctor called “Doctor Willard Bliss” foisted on him. Doctor was actually his first name and in most of the description of this man, he is known as “D W Bliss”. Bliss was a rogue, in that he ran away under fire at the Battle of Bull Run, and then claimed that he participated in a great victory. He faced prison for stealing Army equipment but was helped to evade conviction by his political contacts.  He took the opportunity of an association with Lincoln’s son to spruik a false cancer cure.

Notwithstanding that, he bobbed up as Garfield’s personal physician again on Lincoln’s son’s recommendation. He was completely disdainful of Listerian concepts in mitigating infection. It is not reported whether he ever uttered something like “fake news” or “hoax’. However, it was his complete repudiation of infection control including shoving unsterilised instruments into the President’s body in a vain attempt to find the bullet that accelerated the President’s ultimate demise.

Despite a welter of optimistic reports on the progress of the President’s condition, completely fake, Garfield died on September 16 – two months after the assassination attempt. A long pus-laden sinus was found in the President’s body at post-mortem – the track outlined where Bliss’s probe had gone.

At trial, Charles Guiteau, the would-be assassin,  said in his defence that he did not kill the President, Bliss did. Nevertheless, it was Guiteau who was convicted and hanged in January 1882.

In fact, Bliss billed the US Government for an outrageous sum for services rendered, but in the end received nothing.

Real gallows humour, because with Bliss, quackery and fake news clashed with scientific evidence. Scientific evidence and the life of a President were the victim of the Bliss cocktail.

Ambulant recognition

Simple things are often lost in the grand sweep of the disabled. One of the problems with being disabled is the lack of uniformity of public toilets, those in restaurants and also those within service stations which are the most easily accessible, unless the service station has a sign which says “Express”, which stands for “no toilets”.

The problem:

There are four essentials.

  • The toilet seat must be about 50 cm from the floor.
  • There should be a rail to hold on to when standing up.
  • There should be a handle on the inside of the door; just try getting the door open if you have only a small bolt handle and you are too weak to use it.
  • There is a need to have an ambulant toilet, the use of which should be enforced with appropriate signage in each of the male and female toilets, so the first stall can double as the ambulant toilet with appropriate adjustment in size.

I am going to name one toilet. The one at the Pheasant’s Nest Service Station which is one of last on the Hume Highway before Sydney, and therefore has a strategic importance if you do not want to be caught short on the freeway, caught in an unexpected gridlock.

The disabled toilet has been converted into a shower for interstate truck drivers and was locked. You can hold all the Royal Commissions in the World, but the recommendations often float away.

It would be very useful if there was an enforceable guide for toilets – then there may be an attempt to get uniformity, to conform to the standards, which are clearly set out if one can be bothered to read them.

In Namibia, I once flew for more than three hours in a light aircraft with a bottle for use in the emergency. The flight was from Windhoek to the Hartmann Valley in the north-west of the country, close to the Angolan border. There, alongside the airstrip in magnificent solitude, was one the cleanest flush toilets I have ever used.  That was a very good definition of “relief”. I called the toilet – Mafeking.

Hartmann Valley

Dial M for Misnomer

I had one of those “Four Weddings and a Funeral” moments recently. You know when:

Charles:  How do you do, my name is Charles.

Old man: Don’t be ridiculous, Charles died 20 years ago!

Charles: Must be a different Charles, I think.

Old man: Are you telling me I don’t know my own brother?

This day, I was in a hurry and I thought I had transcribed the phone number correctly.

I rang. A familiar voice, as I thought, answered.

“Marcus, this is father.”

“Don’t be ridiculous. My father died 40 years ago,” followed by a piece of unnecessary invective.

The receiver was slammed down.

I checked the phone number. It was that of one of my cousins who was born grumpy. His name started with “Michael” but although I see him infrequently, I know he is deaf. I could not be bothered ringing him back.

Mouse Whisper

At last, the Trapdoor has been removed and I have been able to visit Melbourne and all my mouse mates who went to Murine Grammar School. I was with a wise friend, Melchior who travels every year here with his two friends, Balthazar and Caspar. Melchior in not Australian but apparently COVID-19 immune.  As we ran along a Melbourne street, we saw this newspaper poster on the newsstand:

SMITH

BLASTS

TON

Melchior was at once fascinated since Melchior is familiar with gold. So he pondered; “Goldsmith?”

“Blasts?” explosives –

“Ton” – unusual for a goldsmith to mine his own gold?

Melchior said such was the rarity no wonder it had made news.

“Good try but not quite right, Melchior!” was all I whispered.

Modest Expectations – Arthur Phillip

This is my 88th blog. I have not missed a week – and the sequential naming of the Modest Expectations to reflect that number in some way. 1988 – the Bicentenary of this Nation was quite a year. I received funding from the Commonwealth Department of Health to write a book where I asked a number of health professionals how and why they were there in Australia in 1988, at the time of the Bicentenary. It was called “Portraits in Australian Health” – not a particularly riveting title.

However, what I wanted to see in their recounting of their lives was why at that point of Australia’s history, they were where they were. The backdrop to each of the lives of those interviewed was Australia.

This idea was expanded by the BBC in 2004 where they identified celebrities and took them through their genealogical paces with a predictable chorus of “gosh” and “unbelievable” and “who would know?” as each of the atavistic eggs was unscrambled. All beautifully orchestrated.  By and large the people chosen were performers, who could act the part of the stunned inheritors of their family helix.

I suspect that the budget for these TV shows is generous, because it showed that people are curious about other people. “Celebrity” gossip is the fare of the magazines which concentrate on a vague representation of the truth. The BBC, as did I, actually did research!

My concept was relatively simple: sit the person down and let him or her talk. Some I had known before; others only by reputation and I tried to achieve some sort of balance. A few I regret using; others were incredibly important in tracing the path of the reason for their being health professionals and providing “a tapestry” for the 200 years.

However, in retrospect there were at least two major omissions in people from certain categories. There is no dentist in the book; the person I had singled out, because of his long family association with the profession declined to be interviewed; he died not so long after of cancer. That was the only rejection that I remember.

The other omission which, if I could I would rectify, was an Aboriginal person with a health background. On reflection, I should have asked Naomi Mayers, who was the Chief Executive Officer of the Redfern Aboriginal Service. Much later I had lunch with her and a number of Aboriginal people in Redfern and even then I had no inkling of her link to the Aboriginal singing group, the Sapphires. But I didn’t identify her and I regret it.

However, as I found as I met more and more Aboriginals, there was a rich cultural heritage, much of which was hidden from whitefellas. I have always been sceptical of the historical importance of bush tucker, which has acquired a following among well-heeled whitefellas. Much of the tucker available would hardly merit a feed, so tiny are the individual berry, fruit and the other flavouring agents.

However, what I have found very interesting and have met on various occasions were ngangkeri, the medicine men. When I was often visiting Wilcannia in the early 90s, I heard about the kadaitcha men who were still around. However, that was all, and after all “the feathered foot” left no trace; so how would a whitefella find out more. It was all intriguing and the more I was accepted the less I knew.

The Aboriginal society is “many nations” – after all, look at the difference in the culture across the nation. The problem is that in the confected restoration of Aboriginal culture, the diverse nature of the culture has been increasingly homogenised. That cannot be criticised as it recognises that the Aboriginal culture is not static; and given the improvement in communication and educational opportunities it is unsurprising that the Aboriginal is becoming less and less regionally distinctive. Having said this there will always be nests of such traditional culture.

The conundrum for such communities is how to preserve culture against the predatory nature of a culture of booze, fast foods , “black milk” and all the churning of this faddish instant googled-eyed Facebook age – yet not denying progress.

It would be a challenge now to find the Aboriginal health professional who would fit easily into a portrait of Australian health. In 1988, it was only four years since the first Aboriginal doctor graduated.

Charlie Perkins

Charlie Perkins

I was thinking about the first time I met Charlie. It was obviously in 1973, and up until that time, all I had heard about him was that he participated in the Freedom Ride to confront rural NSW concerning Aboriginal rights. To the urban Australian living in comfortable suburbia, Aboriginals were invisible.

As I child I remember receiving Church Missionary Society pamphlets about all those nice little Aboriginal children running around in Roper River Mission – so happy to be one of God’s lambkins. It was all so foreign, and the first time I saw real, live Aboriginal children was years later when I went with my parents to Central Australia. Part of the tour was a visit to the then Lutheran Hermannsberg Mission. We white children eyed off the Aboriginal children, who did likewise and giggled at this awkward bunch of kids from down south.  Nobody encouraged us to mix and eventually we got back on the bus and left. There were also the blackfella children in the settlements along the old Ghan route which then wound through the floodplain country and terminated in Alice Springs.

I remember I insisted in Alice Springs that my parents buy me a black ten-gallon stockman’s hat, and even though I have a large “scone”, the hat came down over my ears. My other purchase caused all sorts of bother, and when it was brought home it had its own “cordon sanitaire” because the ochre covering this large bowl was very thick and had never been fixed, so if you touched it, the ochre always stained your hands. Eventually the bowl disappeared from the house – as did the hat.

Hermannsberg Mission

However, there were several episodes of the ABC lunchtime serial “Blue Hills”, which have remained with me. These concerned a storyline where Aboriginal Heritage would lead to “a throwback” situation which meant that apparently white parents with Aboriginal blood could be confronted with a “piccaninny” child. Then, as the serial progressed, what relief – Aboriginal heritage was diluted – absorbed – assimilated – and joy of joy – no return to the noble savage. Well, that was the gist of the serial story and reflected the attitude of Australian suburbia superficially encased by a white picket fence of normality.

There were three films that I remember in my early childhood leading into teenage years. All had a variable effect on the development of my attitudes towards Aboriginal people. After all, I grew up in a world dismissive of our landlords. The 1947 film Bush Christmas starred a 12 year old Aboriginal boy from Woorabinda in Queensland, Neza Saunders, who showed how to eat a witchetty grub. At that moment, I wanted one to eat. A gourmet meal of witchetty grubs sadly still remains on my to do list.

The film Pinky explored the plight of the light-coloured black American in a 1949 film of the same name. I remember in the context of a society which, despite the pious comments of my schoolteacher, remained at its base racist. We, as children because we grew up in a homogeneous culture, did not have the basic experience to question. However, for me, it instilled in me a sense of unease, the word “miscegenation” still unknown to me.

This unease was reinforced by Jedda, a film where the central tragedy of the Aboriginal was played out in Charles Chauvel melodrama. Jedda was such a beautiful young image for myself, a teenage boy. Years later I went to Utopia, an Alyawarre settlement on the Andover Highway. As an Alyawarre woman, she had grown up there and later had a troubled relationship with the community.  I did speak to her on the telephone but she was away when I stayed in Utopia.

It was still a long time from Jedda before I was to run across Charlie Perkins. I do not know why but we had an immediate empathy. One problem I had noted was that Aboriginal reticence meant that you had to learn to speak through the silences. As one of my Aboriginal brothers would say, the non-verbal conversations with the various vocal clicks was difficult for whitefellas so used to voice communications. The other manifestation that was clear from a growing association with Aboriginal people was if a particular government meeting was thought irrelevant, the Aboriginal representative just did not turn up, but as the Aboriginals have come in from the fringe that dynamic changed. Aboriginal people can recognise tokenism.

In 1973 in Parliament House it was demonstrated very clearly that here was a nation wrestling with the Menzies’ legacy and in particular the engagement in Vietnam. Whitlam terminated Australian involvement, and both he and the Leader of the Opposition, Bill Snedden visited China that year. Snedden was privately concerned with the lack of involvement with Aboriginal People, since even though the 1967 referendum was an overwhelming affirmation of Aboriginal rights that was not easily translated into a workable outcome for our society.

Aboriginal tent embassy

Charlie Perkins, when he was young, had this busy enthusiasm about him. Snedden suggested that I might try and talk to him. The easiest way to talk to him was around the campfire which the Aboriginals had started outside Parliament House. We got on well from the start and spent a lot of time yarning around the fire. To me it was symbolic of establishing an understanding, and Charlie was appreciative that somebody from the Opposition had bothered to brave the fireside. It did not take long for the message to come back from one of the Nats who had seen me with Charlie around the fire saying: “Who’s that Communist working for Snedden?” The other occasion that I well remember was walking with Charlie across King’s Hall one evening, when Mick Young with Eric Walsh came up and said to Charlie without acknowledging me, “You coming to dinner, Charlie?” Charlie shot back, “No, I’m going to have a meal with Jack Best.” These are in the order of things inconsequential. Both Charlie and I wanted a better world and we threw out ideas, most of which drifted off in the camp fire smoke.

So did we, drifted away from one another. Much later when I met him when he was a senior public servant, he seemed to have lost much of this zest for life, but then that happens when you become a fully-fledged bureaucrat.

However, he was also fighting renal failure.

I read Pat Turner’s Charlie Perkins Oration this year, and even though I am not sure I agree with everything she said, she was right in saying that Charlie – the Charlie I knew – never backed down. Yet he showed a willingness to engage in all sides of politics. Later I was to have quite a bit to do with Congress, the Aboriginal Health Service which grew out his early activity in Alice Springs. It is a pity Charlie died while still a relatively young man, succumbing to one of the sequelae of that most deadly infections to Aboriginal people – the streptococcal bacteria.

Conquering that scourge of Aboriginal people still remains. It is not the only one.

Charlie to my mind was the first person who taught me the etiquette of equality of the whitefella in the eyes of the Aboriginal person.  I never attained the level that we could have called each other “brother”, but he enriched my life. Aboriginals were not a cute fringe eating witchety grubs, playing in mission dirt or conforming to a stereotype imposed on them.

Thanks, Charlie for being around when you were – brief as it was. However, you opened up a new perspective for me, and in so doing enriched my life in so many ways.

John Kitzhaber Concludes – A New Model for the Nation

Dr John Kitzhaber

A financially sustainable system designed for value and health can take many forms, but it must include five core elements:

  1. Universal coverage;
  2. Defined benefits;
  3. Assumption of risk by providers and accountability for quality and outcomes;
  4. Capped total cost of care through a global budget indexed to a sustainable growth rate; and
  5. Cost prevention by addressing the social determinants of health.

Here is one example. Starting with our current public-private financing structure, modify the three large insurance pools that currently define the US healthcare system.

  • Pool 1: To achieve universal coverage (element 1), restore the ACA individual mandate but ensure that people have affordable health plans in which to enrol. Expand Medicaid eligibility to include the 28 million people who are currently uninsured or create a new, affordable, publicly subsidized option to offer them. At the same time, move Pool 1 to a CCO-like capitated model that encompasses elements 2 through 5. If coverage in the individual market is unaffordable, those below a certain income level (e.g. 450 percent of the federal poverty level) could buy into Pool 1 with income-based cost sharing, which would make universal coverage more feasible. This is particularly important today as millions of people are losing their employment-based coverage and moving to Medicaid or the individual market.
  • Pool 2: Because Original Medicare is still paid through fee-for-service, the program must be moved to a capitated model. One approach would be to create incentives to enrol in a Medicare Advantage Plan (most of which are already capitated) and change the Medicare Advantage Plans that are still fee-for-service to capitated models that meet elements 2 through 4. Because reimbursement would now be based on managing cost and improving health, Medicare Advantage Plans would better incentivize providers to view their patients as a whole through, for example, nutrition counselling or working with social services for safe housing, thereby meeting element 5.
  • Pool 3: Allow the remaining markets—employer-sponsored medium and large group and self-insured markets—to operate as they do today, negotiating prices with health plans and using their market power to insist on capitated risk contracts with provider networks. The public sector price negotiations outlined below would provide a benchmark, giving employers additional leverage in negotiating prices in the commercial market. This advantage should be amplified by forming new partnerships with Unions

Continue the transformation by using the consolidated purchasing power of Pools 1 and 2 to negotiate one set of prices for both pools. This would include not only what providers are paid per beneficiary (risk-adjusted according to each beneficiary’s expected care needs) but also prescription drugs, medical devices, laboratory services, imaging, and all the other niche business models that have been established under the fee-for-service model to maximize revenue. This kind of price negotiation is what most large private employers (making up the majority of Pool 3) do today. Public payers should follow suit by using the consolidated purchasing power of the public sector—which is footing an ever-larger part of the bill—to get the best price and value for the United States of America community. If the public sector were so inclined, it would also be possible to both negotiate limits on individuals’ out-of-pocket expenses and ensure there are no caps on annual or lifetime benefits.

The result would be a new system of universal coverage built on our current public-private financing structure. With the majority of Americans in some form of capitated risk model, this new system (1) reduces the total cost of care through price negotiations, a global budget indexed to a sustainable growth rate, and provider accountability for quality outcomes; (2) preserves consumer choice and allows current insurers to compete for Pools 1 and 2 in a restructured market; and (3) delivers more and more value and health because it requires strategic, long-term, effective investments in the social determinants of health.

This is merely one way to design a new, health-focused, financially sustainable system. There are others. My objective here is not to advocate for the example I have just outlined here, but rather to spark a new debate that will lead to a better system. Instead of being constrained by what currently exists, we need to start with our objective, agree on essential elements, and then let the contours of the new system emerge. Long-term, this will serve us better than starting with a plan that may not meet the criteria needed to achieve our goal. For example, while both Medicare for All and a public option are ways to achieve universal coverage (element 1), neither directly addresses the total cost of care (elements 3 and 4) or focuses on increasing investment in the social determinants of health (element 5). Surely, we can imagine linking the total cost of medical care to a sustainable growth rate within the next few years. Then we can work backward to create a health system that meets the objectives of Democrats by expanding coverage and improving health and meets the objectives of Republicans by reducing the rate of medical inflation through fiscal discipline and responsibility.

COVID-19 and the Urgency of Now  

As the healthcare system has become ever more dependent on public debt, its financial underpinnings have become inexorably linked to the capacity of the government to borrow. That capacity has been suddenly and dramatically diminished by COVID-19 and by the business closures and high unemployment resulting from efforts to slow the spread of the coronavirus.

To prevent a complete collapse of the economy, there has been a massive federal intervention to keep credit flowing and to provide loan guarantees and direct payments to businesses and individuals. America will have to spend at least $5 trillion this year alone to sustain our economic infrastructure and to support its unemployed. This will leave us with an unprecedented budget deficit and a national debt approaching $28 trillion—with little or no capacity to absorb the 60 percent growth in health care spending that is projected by 2028 (from $3.7 to $6.2 trillion), especially when prices for medical goods and services are projected to account for 43 percent of that growth.

The pandemic is forcing us into an era of dramatic constraints on the public resources allocated to the healthcare system. Neither the government nor private-sector employers can afford the current system anymore, given the economic losses that both employers and individuals have experienced since February and the massive amount of public debt that has been accumulated just to hold our economy together. At the same time, those parts of the healthcare system that have been hit the hardest by COVID-19 are those most dependent on fee-for-service reimbursement, which exposes the basic flaw in a business model that depends on volume, regardless of the value of the services rendered.

This economic crisis means that, for the first time, the economic interests of workers, employers, the government, and many parts of the healthcare sector are aligned. The time to transform the system is now. We have crossed the Rubicon, and there is no going back. We can either watch our current system unravel, with millions more losing coverage and ever-widening income inequality, or we can work together to design a system that helps stabilize our economy and better serves the needs of the American people.

The Role of Unions

This is the moment for more states, facing huge general fund shortfalls, to move to a CCO-like care model for Medicaid, and for Congress, facing staggering debt, to create incentives for Medicare beneficiaries to enrol in a Medicare Advantage Plan and to move that program to a fully capitated model in which providers assume risk for quality and outcomes. Health professionals should be vocal advocates for both of these changes—and that advocacy should be backed up by the strength of the union movement to bring this model to the commercial market. This will require forging new alliances at the bargaining table between Unions and payers—both public and private.

Coverage of the cost of healthcare is, of course, part of the total compensation package, which means that in collective bargaining, wages are often pitted against health benefits. For public employees, general fund appropriations for healthcare compete not only with general funds for wages but also for essentials like increasing nurse staffing ratios, reducing class sizes, and investing in housing and other social determinants of health. The traditional goal in bargaining over healthcare is to reduce, to the greatest extent possible, out-of-pocket costs for Union members (which is very important).

The problem is that focusing only on this aspect of the total compensation package—without questioning the cost structure, quality, or efficiency of the care being purchased—suppresses wage growth. Without aggressively challenging the cost structure and value of the healthcare being purchased, the dollars spent on rising premiums flow into a system that redistributes them upward, taking money from the pockets of working Americans to enrich the profits of large corporations and wealthy individuals (further exacerbating income inequality).

A CCO-like model would be better because it caps the total cost of care without sacrificing quality and it realizes savings to invest in the social determinants of health—including wages. Particularly for workers making minimum wage or close to it, income is a primary driver of health.

Employees and employers have a shared economic interest in reducing the rate of medical inflation and in focusing on value and health. Providers, for the first time, now have an economic interest in changing the payment model from fee-for-service to capitated because this is the only way they can survive in an era that no longer can sustain debt financing. From the standpoint of the Labour movement, CCO-like models could result in increased wages, better staffing ratios, and more funding for education and other services that are critical to making our society more just.

This need for greater social investment must  emphasized. Reducing the total cost of care will assist all working Americans (not just those with union representation) because it will make not only their wages go further but also relieve them of the anxiety of not knowing whether the next illness will push them into bankruptcy. And it will give us, at last, the ability to address the conditions of injustice that underlie disease.

Let’s Begin Now!

Creating a new system with the five core elements will take time. But there is much we must do quickly. Because the economic consequences of the pandemic—particularly the increase in unemployment, with its associated loss of workplace-based coverage—are driving us toward Pool 1 (Medicaid, the uninsured, and the ACA marketplace), this is the logical place to start.

The most urgent coverage problem is for those who are not offered or have lost workplace-based coverage and whose income is too high for Medicaid (above 138 percent of the federal poverty level) but too low to afford the individual market. These struggling individuals are joined by a growing number of underinsured Americans who are technically covered by employer-sponsored plans but face copayments and deductibles so high that for all practical purposes they are uninsured. People of color—particularly Black, Hispanic, and Native American people—make up disproportionate numbers of both of these groups.

The state of Oregon offers an illustration of both the problem and the opportunity. By the end of April, 266,600 Oregonians had lost their jobs (an unemployment rate of 14.2 percent). An estimated 215,800 of these people will be eligible for Medicaid, 20,500 will move to the ACA exchanges, and 30,300 will remain uninsured.20 Because Medicaid is entirely financed with public resources and the ACA exchanges are heavily subsidized with public dollars, this amounts to a dramatic increase in public sector financing of healthcare. In terms of the healthcare model proposed in this essay, Oregon’s Pool 1 is expected to increase from 34.9 percent to 41.3 percent of the state’s population over a few months.

Furthermore, if 80 percent of those who lack health coverage in Oregon made use of coverage for which they are currently eligible—Medicaid or the subsidies available through the ACA marketplace—the number of Oregonians who are uninsured would drop from almost 250,000 to 34,000 (from 6.2 percent to < 1 percent). The only obstacle is the total cost of care.

Since states are facing enormous budget deficits and the federal government is facing a looming debt crisis, it is imperative that shifts toward public financing be accompanied by effective mechanisms to reduce the total cost of care through global budgets (indexed to a sustainable growth rate, with providers at risk for quality and outcomes). At the same time, such global budgets are now more appealing to many hospitals and primary care practices because of the sharp loss of revenue among those with fee-for-service models.

Mouse Whisper

I know we were all keen on Amy Klobucher, when she seemed to be the most articulate candidate back in those days when the Democratic race was like the first at Rosehill. She dropped out, and although considered as Biden’s running mate, she missed out here also to Kamala Harris.

However, the most final reason for her not getting the nod was:

She’s from Minnesota!

In explanation, no Minnesotan has ever made President, and such a judgement tends to stick once voiced. At least Barcelona is not in Minnesota.

Modest Expectations – Derby Day in Walla Walla

State Capital West Virginia

It was late in the day some years ago and we had just driven past the capital of West Virginia, Charleston. The golden capital strikingly stood above the low-level smog which was layered over the city itself. Here we were in the Alleghenies, a 640 kms portion of the Appalachia, a rich source of coal. Here pitched battles were once fought between the miners and the mine owners – called the coal wars. The reason lay in the fact that during this period more miners were killed here in accidents than were lost by the US armed forces in World War 1.

West Virginia had been carved from Virginia in 1863 during the American Civil War, partially because the West Virginians did not follow most of Virginia which seceded at the outbreak of the American Civil War. Yet the electoral base and its Democrat traditions lay in its workers, radical by American unionism standards, reinforced by the memories of the coal wars.

I wondered, as we approached the entrance to this property with its imposing edifice, whether it was a hotel where we could stay for the night. I drove in and the colonnaded entrance suggested that perhaps I had inadvertently driven into a private estate. However, I got out of the car, in jeans and all, and entered the building in all innocence to enquire what was this place.

The Greenbrier

The man behind the reception desk looked me up and down and said, “Sir, this is The Greenbrier.”

As I learnt very quickly, The Greenbrier was the place where Presidents stayed, and I found out there were references to them as far back as Polk and Tyler. I thought the car parking space for the resident golf professional at the time, Sam Snead, said it all. This was a comfortable Republican enclave in the heart of what was a poverty-stricken mining area. I remembered once, on a flight north in Australia, there was a dishevelled guy sitting next to me. We got talking, although I had difficulty understanding him; he turned out to be a miner going up to the coal mines in Queensland. He was from West Virginia, and his mumbled English was full of archaic constructions and words that meant nothing – it was a dialect probably based on 17th or 18th century English. In the end, in the light aircraft, the noise of the plane made it impossible to talk and we lapsed into silence.

But back to The Greenbrier. The Government had built a huge bunker at the hotel during the height of the Cold War, which had the capacity to house the whole of the Congress in the event of a nuclear attack. The facility had long been decommissioned by the time we had stayed. I believe I was punished for my disrespectful comment as the room assigned was so far from the main building that it almost collided with the fence and was well behind the bunker. Still, they allowed us into the dining room.

However, before that could occur, the reception desk clerk had said, “If you wish to dine in, sir, you will need a jacket.”

“No worries.” I had a jacket – a blazer in fact.

A key was pushed towards me. The Greenbrier had welcomed us, after a fashion. Menofregismo as the Italians would say.

West Virginia has always been reliably Democrat, but now no more.  The three Congress members are all Republicans; only one of the two senators is a Democrat and over 50 per cent of the time he voted with or for Trump, even in the impeachment he was only one who crossed over from his Democrats for Trump.

From being reliably Democrat, now West Virginia is almost the most Republican State if judged by the vote for Trump here recently – all changed in a decade! Biden received less than 30 per cent.

The use of coal is rapidly dying, so it would be a useful exercise for the Biden Government to determine how to restructure the West Virginian economy to phase out coal. It is more difficult than just bribing the mine owners to provide the semblance of work by keeping uneconomic mines open. However, it probably would be just as cheap for the Government to bypass the owners and pay the miners a living wage disguised as a redundancy package or employ them to resuscitate the once pristine landscape mined over the past 150 years.

After all, the wealthy and influential were prepared to invest in an opulent playground here, including the Congress shelter bunker. Notwithstanding that it had been decommissioned well before we stayed, here was further evidence of the very essence of privilege in one of the poorest parts of the country.

The latter part of the last century and into this, first as governor and then as Senator, Jay Rockefeller, the great-grandson of John D Rockefeller, as a Democrat (unusual because the rest of the family were solidly Republican) won most of his elections by huge margins. There is little doubt that during his long association with West Virginia he and the coal industry were on very good terms – for most of the time. However, towards his retirement, he began to realise the impact of coal on climate. Two years before his retirement, in 2012, he made in the following statement:

Scare tactics are a cynical waste of time, money and worst of all coal miners’ hopes. But sadly, these coal operators have closed themselves off from any other opposing voices and few dared to speak out for change – even though it’s been staring them in the face for years.

This reminds me of the auto industry, which also resisted change for decades. Coal operators should learn from both the mistakes and recent success of the auto industry. I passionately believe coal miners deserve better than they are getting from operators and West Virginia certainly deserves better too. 

Here in Australia the problem is that fear has gripped Joel Fitzgibbon, not any constructive thought. His livelihood lounging on the plush red seats of Parliament House is threatened. Forget about climate, but then there are unions agitating for retention of coal mining, and the power of the unions depends on these miners coughing up subscriptions – but for what? As with the car industry, government subsidy for the uneconomic only ends up improving the bottom line of the big foreign-owned companies.

The slick Monsieur Perrottet wants to restore his stained escutcheon by expanding the coal industry in NSW to pay off a short-term debt and in so doing leaving an incalculable environmental debt for generations of Australians; the feathery Premier just keeps talking to see if she can break the world record for not taking a breath. There is some in government with a contrary idea of how to lessen the coal dependency, despite export prices for both coking and thermal coal are being maintained.

Yet there is fear of divesting away from coal. This has been aggravated by the electoral results in Queensland, and by the “near-death experience” of Fitzgibbon in his seat of Hunter. The other NSW coal seats did not seem to mirror the same extreme behaviour.

There is another problem, and that is the Fly-in-Fly-Out miners. This expanding cohort should not be confused in the arguments over the hearts and minds of the local coal miners.

As one local Mount Isa correspondent has written:

The issue of Fly In Fly Out did not get much of a look-in in the federal election, perhaps because it is mainly seen as a state issue.

FIFO is convenient for workers who want to live by the coast but still enjoy high-paid jobs in remote locations.

It is also convenient for companies who have better control over their staff and their movements whether it be on chartered flights, mining camps or buses.

But it is a terrible deal for places like Mount Isa and the towns of North West Queensland which get all of the downsides of a large mining operation on their doorstep but few of the benefits.

Yes I understand that airports, motels, pubs and clubs, and the like do well out of a transient workforce but other businesses not so well.

The wear and tear of mining operations on roads and other facilities is a cost borne by those communities. And only this morning did I hear a speaker at a MineX breakfast talk about the need for a local work force because without that “we have no social licence to operate”.

The Queensland government recognised the issue with the Strong and Sustainable Resource Communities Act introduced last year to ban 100% FIFO mining near towns like Mount Isa and Cloncurry.

However, companies can get around this simply by posting one staff member locally which meets the wording of the act but not the intent.”

Balmain coal miners

Great is it not; with one selfish self-centred politician intent on contaminating the narrative of moving away from coal.  A leader, if one can term Albanese that, should have called him out immediately.  Or do I do Mr Albanese a disservice. Maybe he really wants to see the Balmain coal mines re-opened in his electorate.  Fitzgibbon can’t have it all his own way. After all, my late neighbour used to tell me that, as a boy, he would go around the corner to the coal dump and bring coal home for the stove and the fire. It was said that Balmain was then quite a sooty turn to behold.

As a 40-year resident, I remember seeing the entrance to the mine.   After all, to that smooth genius, Monsieur Perrottet, reopening the mine shafts under the Harbour would bring lots of “coal hard cash” and so convenient – or not. And what a jape – reopening a coal mine in a Green electorate. Problem is that is where Perrottet and his fellow travellers want to scar Australia, the wildlife do not vote. However, in Balmain, I am assured that Monsieur would find a different form of wildlife – one that rumbles around the suburb in their Land Cruisers looking for anybody with a lump coal in their political pocket. After all, Monsieur wants to demolish the White Bay Power Station – perhaps a new location for an underground coal mine.

But I stray from my West Virginian narrative – at least I have a narrative.

While America looks away.

I was rummaging through my old magazines and I came across a copy of a Harper’s dated August 1999, in which there is an article where two journalists were assigned to report on Cyprus – flipping a coin to determine which of them travelled to the Turkish Republic of Northern Cyprus and the other to the Republic of Cyprus. As the lead-in to that article, it was stated; “Cyprus remains partitioned, a case study in how ethnic hatred perpetuates itself but perhaps also a manual on how peace can be sustained in places like Kosovo”.

It was nearly 20 years later that my friend and I walked across the Green Zone that separated the two sides of the divided Nicosia, the major city of Cyprus.

There is something strange walking across what is essentially the line where battle formally ended.  A few peacekeepers wearing blue berets are moving around inside the buildings and the only sound is a radio blaring out modern pop. There is nobody to block our crossing through the rubble strewn street, only a strange sense of abandonment, although you know eyes are watching you in the CCTV cameras slung along your pathway. Passing from one side to the other met with little interference from the Cypriot or Turkish side.

Once we were across then there was the question of transport. We did not have to wait long before a taxi pulled up and took us to Kyrenia, a seaside town on the Turkish side where we had a pleasant seafood lunch. The taxi driver said he would return, and he did, punctually. The only noticeable difference from one side to the other was the appearance of mosques; the cars still drive on the left, irrespective of which side of the green lines one drives.

Cyprus is the only place outside the British Isles and the Republic of Ireland in Europe where there is a remnant link to the previous British occupation – driving on the left hand side of the road.

In 1878 Cyprus entered the British Empire under rather unusual circumstances. The Ottoman Empire had just been at war with Russia and were very much in danger of losing control of their capital Constantinople. The British intervened in the crisis on the side of the Ottoman Turks by sending a fleet to intimidate the Russians. The Ottoman Sultan was so thankful for the British intervention that he granted the control of the island of Cyprus to Queen Victoria. This lasted until 1960 when independence was gained. Throughout the 1950s a Greek terrorist group EOKA, under a former Nazi collaborator George Grivas, exacted a price on British occupation, a killing spree of British soldiers and Turkish Cypriots in the main.

The British still retain armed forces bases there on territory that was ceded to the United Kingdom on independence. That means that slivers of Cyprus remain British soil.

While there was a myth abroad that the Turkish and Greek Cypriot relations had been harmonious before the invasion but after Independence, that was far from the truth. The Green Zone actually began a line drawn by the British in 1963 because of strife between the two.

By 1974, the treatment of the Turkish Cypriots was bad enough for Turkey to intervene, and it did not take that long for the Greek Cypriots to quickly sue for peace. This led to fragmented jurisdictions, separated by a UN peace force which have, since the ceasefire, patrolled the Green Zone that extends across the island, cutting through Nicosia as mentioned above.

There the line has remained intact despite regular exchange of obscenities, rock throwing, and the more serious “cocking and pointing”.

When the Harper’s article was written there was very limited access across the border. The two journalists met once, face to face, for coffee in Pyla, a small fishing village within the Green Zone.

There may have been calm when we visited, but there was residual bitterness. We were there at a time before Erdogan came on the scene with all his populist fury. However, he probably recognises what one Greek Cypriot soldier said when asked whether he would retaliate: “No,” he said smiling, “We are careful not to provoke them, because we are the weaker side.” 

Erdogan must know that and after the defeat of Armenia recently, he may be tempted to have a “go” at Cyprus.

Apart from the increased access across the Green Zone, since the 1999 Harper’s article was written, another phenomenon has occurred. It was first evident when I picked up the menu at the hotel in Limassol where we were staying. The menu was not only in Greek and English but also in Russian. The Russians have made a large investment in Cyprus – either with or without Putin’s collusion. Who would know the extent of each?

Now there is a cohort of Russians who have not only invested in property but also have bought Cyprus passports, a practice contrary to EU rules. Under pressure from the EU, Cyprus has now withdrawn that permission to buy into the Republic. Unlike Armenia, Cyprus is a member of the EU, but the Russian passports have not been cancelled.

However, would that matter given that America is now  distracted and if the Turkish Cypriot grievances are inflamed by Erdogan, how would the Republic respond? Seek Greek support? It was not there in 1974.   Would it be now?

The European Union?  Does the EU want to go to war with Turkey, a member of NATO? After all, it was NATO bombing of Serbian held positions and a USA-brokered peace which, in the 1990s, ended that perennial obsession of the Serbs to dominate the Balkans.

This is different political chemistry, and one without a strong America, with a lame-duck President with Russian connections still at the helm. Cyprus has inhospitable mountainous areas. Don’t we know it? We got lost in the wilds of Cyprus, and only worked our way out by pointing the car down the mountains, but at least there was a track to follow.

So military conquest of Cyprus is not just a case of rolling up to seaside resorts like Limassol and Paphos in Turkish tanks. The mountains are perfect for guerrilla warfare.

So-called Russian peacekeepers could already be there to help – and themselves – as they have done in Armenia. They might be there to welcome the invading Turks.

As for the sovereign British bases, maybe Boris would let the Russians have them. After all, he could say it is part of his Brexit plan. Hopefully no one would write, as Queen Mary did with “Calais”, that Cyprus will be written on his heart.

Nevertheless, it should not be ignored that the Russians doing the Trump

Presidency have built up a seasoned defence force, which has honed its skills in Syria and elsewhere. Why not Cyprus? Why not indeed!

John Kitzhaber continues his analysis of the US health system…

Dr John Kitzhaber

Public Resources

We need to understand the central role of public dollars in our healthcare system. Healthcare is the only economic sector that produces goods and services which none of its customers can afford. This system only works because the cost of medical care for individuals is heavily subsidized with public resources. This happens directly through public programs like Medicare and Medicaid. It also happens indirectly through the tax exclusion for employer-sponsored health insurance and through the public subsidies in the individual insurance market established through the Affordable Care Act (ACA).

As a result, about 90 percent of Americans depend on public subsidies to help them cover the cost of their care—all except the 28 million Americans who remain uninsured. These people are not eligible for a public subsidy themselves, but through their taxes they help subsidize the cost of healthcare for everyone else. This egregious situation reflects the systemic inequality that exists not only in our healthcare system but also across our whole society.

Thus, the central issue in the healthcare debate involves the allocation of public resources, which represent a kind of fiscal commons. They are shared resources raised from society as a whole—and they should be allocated in a way that benefits all of us, not just some of us.

The National Debt

We also need to recognize that our healthcare system is increasingly financed with debt. Why? Because public resources are finite and Congress is borrowing ever more money to pay for existing programs and services—including health care. This fact is reflected in the congressional budget deficit and in our national debt. The national debt is the accumulation of years of budget deficits and represents the amount of money that has been borrowed to cover the difference between congressional spending and the tax revenue available to pay for it. Since healthcare now accounts for over 28 percent of the federal budget not spent on interest—and is projected to grow to 33 percent by 2028—it has become a major driver of the national debt.

This means that as the population ages and the cost of care continues to rise, the economic viability of the healthcare system will increasingly depend on borrowing money—and on the capacity of the federal government to absorb more debt. If the capacity to borrow is constrained, the financial underpinnings of the healthcare system begin to unravel. Since COVID-19 has created exactly this constraint on borrowing, a healthcare financing crisis that was on the horizon is now at our door.

Income Inequality

Furthermore, a growing share of the money borrowed to prop up our medical system is not being used to expand coverage. Instead, it is enriching the profits of large corporations and wealthy individuals. Let me be very clear: our current healthcare system is increasing income inequality through a process called rent seeking. This occurs when powerful stakeholders manipulate public policy to increase their own wealth without the creation of new wealth (i.e. they take more of the pie without making the pie bigger). For example, when the pharmaceutical industry convinced Congress to prohibit the government from negotiating drug prices for the 60 million Americans on Medicare, it distorted the market by putting the power in the sellers’ hands to set whatever prices they wish. After many news stories about “big pharma”, more people have become aware of concerns with drug prices. What seems to be less well known is just how profitable medical insurance is: in 2019, the seven largest for-profit insurers had combined revenue of over $900 billion and profits of $35.6 billion, a 66 percent increase over 2018.The result of the rent seeking that is evident throughout the health care industry is lower disposable income for the individuals who have to pay those inflated prices, increased profits for the companies, and wider income inequality.

Health versus Health Care

Finally, we need to recognize that the goal of the healthcare system should be to keep people healthy, not just to finance medical care. In other words, it needs to address the social determinants of health—access to healthy food and clean water, safe housing, a reliable living wage, family and community stability, and more—which have a far greater impact than medical care on the health of both individuals and communities. Yet the ever-increasing cost of care compromises our ability to invest in these things.

Today, healthcare providers and the system have different goals. While most care providers are trying to enhance people’s health, they nevertheless work in a system where the incentives are to increase profits and redistribute more wealth to the wealthy.

Confronting the Total Cost of Care

Improving health requires a financially sustainable system that ensures that all Americans have timely access to effective medical care

and

that makes long-term investments in the social determinants of health. To achieve these dual goals requires five core elements:

  1. Universal coverage;
  2. A defined set of benefits;
  3. A delivery system that assumes risk and accountability for quality and outcomes;
  4. A global budget indexed to a sustainable rate of growth; and
  5. A cost prevention strategy that allocates some of the savings to addressing the social determinants of health. A system that incorporates these elements can take many forms, but without all five we cannot achieve our goal of improving health in a financially sustainable way.

There are two primary obstacles keeping us from moving toward a new system focused on value and health: the way the debate has been framed, and the cost-shifting strategies that—until the pandemic—allowed us to avoid the growing discrepancy between the cost of the system and our ability to pay for it.

How the Debate Is Framed

For decades, the national healthcare debate has been paralysed largely because neither Democrats nor Republicans have seriously challenged the underlying healthcare business model—the debate has been over what level of funding to provide. The current business model is built around fee-for-service reimbursement. The more they do, the more they get paid. Since the fees paid for medical services usually are not linked in a meaningful way to a positive health outcome for the person receiving the care, the system incentives are aligned with maximizing revenue rather than maximizing health.

The Affordable Care Act (ACA) attempted to move away from this model with incentives to participate in accountable care organizations (ACOs), which are networks of providers that shared in savings if they delivered care more efficiently (called upside risk). The problem is that the ACOs were not required to assume any significant degree of downside risk, in which they had to refund a payer if the actual costs of care exceeded a financial benchmark. Furthermore, the ACA did not take on the rent seeking (transferring wealth to the wealthy) that accounts for so much of the cost in the system. As a consequence, the cost of health care grew from $2.6 trillion in 2010 to $3.6 trillion in 2019.

In the wake of the ACA, both major political parties have continued to debate only the extent to which we should fund the system, creating a false choice between cost and access. This false choice is reflected in the Republican view that the cost of health care is unsustainable and must be constrained, and in the Democrat view that any reduction in spending will reduce access. Both sides are right, if they remain wedded to the current business model.

Republican proposals to “repeal and replace” the ACA would simply reduce the public subsidies in the current business model, increasing the number of uninsured Americans and exacerbating the inequity that already exists. Democrat efforts to expand coverage through proposals like “Medicare for All” would significantly increase public subsidies but within the same inflationary fee-for-service business model, adding to the burden of debt that future generations will have to pay. To put it another way, Republican proposals increase inequity and harm people today; Democrat proposals increase the debt and harm people tomorrow.

Cost-Shifting Strategies

Framing the debate in this way allows legislative bodies to avoid directly addressing the cost of care by simply shifting that cost somewhere else, a strategy used by other third-party payers (insurance companies and employers). As the total cost of care increases, instead of seeking to reduce it, these payers take actions that shift the cost to individuals, who cannot afford it, or to future generations. Here are the most common cost-shifting strategies:

  • Reducing eligibility, cutting benefits, and/or raising co-payments and deductibles—all of which shift costs to individuals;
  • Reducing provider reimbursement, which may result in efforts by providers to avoid caring for those who cannot pay and/or lead to increased fees by providers when they are caring for people who are insured; and
  • Increasing debt-financed public subsidies, which shifts the burden to our children and grandchildren.

Importantly, none of these cost-shifting strategies reduce the total cost of care, which is the central structural problem in our system. Before COVID-19, we were able to rely on these strategies, particularly debt-financed public subsidies, to avoid the difficult choices necessary for a solution. But given the economic crisis we face now, we must directly confront the total cost of care. Fortunately, this gives us the opportunity to pursue new strategies that both redesign the current hyperinflationary business model and invest in those things that have the greatest impact on health and well-being.

To be concluded

Mouse Whisper

Out of an abundance of caution

ex abundanti cautela

In law, describes someone taking precautions against a very remote contingency. “One might wear a belt in addition to braces ex abundanti cautela”. In banking, a loan in which the collateral is more than the loan itself. Also, the basis for the term “an abundance of caution” employed by United States President Barack Obama to explain why the Chief Justice of the US Supreme Court John Roberts had to re-administer the Presidential oath of office, and again in reference to terrorist threats.

In reference to Chief Justice Roberts, who flubbed it the first time, Obama recognised the deep conspiracy and made him do it again – correctly. Our authority is the impeccable, Il pagliacco Guiliani.

Just a quote dripping with irony, it has become the favourite phrase of the month, and it seems that is how one formally approaches the Virus, but you must be in full evening dress with all medals displayed (sic).

For we mice it is more that we’re “Out of our barn dance our Cat’s in”.

Modest Expectations – Windy Bears

Blinman is the highest settlement in South Australia at 610metres. It has a pub and one of the distinguishing features of this area is that it sells locally-made ice cream – well, not actually made in the Flinders Ranges but in a little town in this mid north area of the State – in Laura.

The Flinders Ranges were named after Matthew Flinders who, together with his cat Trim, were the first Europeans to see the Range when he anchored his boat in Spencer Gulf near present day Port Augusta, and his name was given to the Range by Governor Gawler in 1839.

Wilpena Pound is an ancient caldera in the Southern part of the Flinders Ranges. It is one of the few places which was still on my bucket list of places I hadn’t been in this vast country. The name had stuck in my mind since I read that the famous New Zealand soprano, Kiri Te Kanawa had performed here in an open-air concert – with the all kit and caboodle of an accompanying symphony orchestra.

Within the National Park now owned by the local indigenous people, the resort is surrounded by hills and the bush crowds in upon you. Ring throated green parrots are cavorting on the terrace as I am setting down my thoughts.

Six weeks earlier the area had been flooded and there is still evidence of water damaged roads. Most of the bush that had been washed along with the floodwaters had been cleared away, but the road signs still warned of flood damage and the unmade roads into the interior of the range had yet to be graded. There are plenty of hikes, which I could have done in the past, but there is still much to see.

 

The Flinders Ranges themselves are not that high, but they have a certain majesty. There is the huge Arkaroola Rock; there are the hills which are swirls of pink accentuated in the afternoon sun. A hill pokes out from the pink diorama as though it is a sand dune not rock. There is the Great Wall of China atop, in American usage, a butte. Nature had constructed what appears to be a dry-stone wall, which meanders up and across these flat-topped hills. Other peaks are jagged, saw toothed. This has been a playground for Mother Nature to experiment in form and texture. After all, to the local Aboriginal people this is the land of the Rainbow Serpent.

Throughout the ranges on the road north to Blinman, the dominant tree is the native cypress and, because of the recent rain, they are growing amid a greenery which has coalesced with the salt bush. There is also the mauve of Paterson’s Curse, which has been let loose by the rain and, as I have written before, it can look beautiful. However, as Baudelaire once wrote, at the heart of great beauty resides evil. I always think of those words when I see this imported weed coating the landscape.

Tiny Blinman has a general store, which was closed, but fortunately the pub offered the ice cream. There was once copper mining here, and the woman at the door informs us that the tour of the mine is full. She gives me some tiny pieces of malachite as compensation. I tell her my great-grandfather, when he first came to Australia, took his family south of the Flinders Range to Kapunda, where the first commercial mine in Australia had been opened in 1842. This mine also yielded copper but has long been closed. I had been there many years ago and already gathered pieces of souvenir ore from the mine tailings.

The view from Stoke’s Hill Lookout is of a red ochre expanse dotted with salt bush. Here the greenery has not penetrated and my whole vision was one that Fred Williams may have seen and painted. After all, the Flinders Ranges was inspiration for Hans Heysen also. He painted many a vibrant gum tree landscape. Although the native cypress are dominant, there are stands of several major eucalypts throughout the Ranges. There is the Southern Flinders Mallee, which grow on the rocky slopes, but along the river-beds are the imposing river red gums beloved of Heysen.

The Big Tree, Orrooroo

The largest of these eucalypts is celebrated in the small settlement of Orroroo, south of the Flinders Ranges, where the eponymously named tree is said to be over 500 years old. It has a trunk circumference of 10 metres and no fork in the trunk until six metres up.  It is a very healthy tree, but it is by no means the only tree of similar size and in the forecourt of our accommodation, there is a tree that is not much smaller. In the reception is a huge red gum counter made from a tree that had fallen over. Part of the massive trunk had been salvaged but the rest, despite protests, was cut up into firewood, the desecration often perpetuated by government-paid foresters.

Hawker is at the southern apex of the Flinders Range, a small settlement but with an enormous tyre service. This is an ominous warning of travel on the unmade roads that penetrate the Range. While we refuelled there, we were surrounded by an exhaust of leather clad motorcycle riders, most of whom were old enough to be directly inspired by Peter Fonda and Denis Hopper in Easy Rider. This is “easy riding” in the Outback, even though the sense of hair flowing the wind is now “kerbed” by a helmet.

The road to the west of the range proceeds north to Parachilna, with a pub and an official population of three. The pub is managed by a young couple who have fled there to escape the Virus, and here gained employment. This Prairie Hotel is a well-known watering spot to where once a railway ran, but no more.

The hotel is deceptive. From the outside it is a normal pub with the corrugated iron roof slung over the walls to provide protection from the sun. However, it is different from the normal desert hostelry in not being a reservoir for stubbie holders, fridge magnets, car stickers, and sexist T-shirts in a dungeon-like public bar. Inside it is tastefully decorated, light and airy.  There is a wide array of quality, mostly Aboriginal, art on display for sale. It is also the general store, sells other Aboriginal-designed artefacts, has good accommodation, the place for a good feed at breakfast and dinner; and being a pub, a wide range of grog. A bottle of my favourite Hendricks gin peeps out of a well-stocked spirits selection. Over the road from the hotel there is the budget accommodation in the form of dongas, ship containers with a portal of entry. Without air conditioning in the middle of summer, they would be like being in a microwave.

The paved road now goes a long way north and last year was extended to Marree (once the cattle railhead) to try and help those “grey nomads” dragging their caravans. Thus, Parachilna is now not a terminus but a welcome stop on the way north into the desert. For us, given how late in the day it is, this was our turning point from where we drove back, bathed in the late afternoon sun.

Adam Goodes mob – The Adnyamathanha

Terence and Josephine Coulthard, in the words of the front cover, compiled a Culture and Language Book on the Adnyamathanha people. These are local Indigenous Guardians of the Flinders Range – the long title means Rock (Adnya) People (Mathanha). The book runs to 450 pages and serves as a dictionary – the written form of the oral language – painstakingly described.

Adnyamathanha flag

These people have a flag (pictured) which combines the blue diagonal canton as representing sky and the Blue Rock people. The brown represents the land and the Red Rock people. The saucepan star formation is the men’s story line; the seven sisters the women’s story line. The circle with the radiating white lines is Ikara (Wilpena Pound) and the symbol for the whole Adnyamathanha community. Thinking about the complexity in the cultural attachments to the land we now recognise as Australia, such a flag should be looked at in a national context. It is a proud flag; this is not the flag of the downtrodden.

This strength was exemplified by us being invited to come to the launch of the book under the river red gums, where Terence sang and played the guitar, where the mob had come  and now sat under the trees and the children ran free the aboriginal kids weren’t running around, they sat with their parents. There was a lot of talk, everybody seemed to have a word to say, including the local member for Stuart with a long Dutch name.

We purchased both the book and the flag.

John Kitzhaber – His Thoughts

Below is a the first of a multipart series by Dr John Kitzhaber, former Democratic Governor of Oregon and the author of the Oregon Health Plan. I have known Dr Kitzhaber for a long time and he has agreed to his essay being reprinted in my blog. It provides an insight into the thinking of someone whom President-elect Biden may tap for ideas. Over to Governor Kitzhaber…

Dr John Kitzhaber

“I started practicing emergency medicine when I was 27 years old, and I still remember the vulnerability of the people who came to see me. They were sick or injured, frightened, and asking for help. They didn’t know me, and yet they put their trust in me. I did everything in my power to help them and yet, even then, I sometimes failed.

As an emergency doctor, being unable to save a life was devastating. The walk across the hall to the small room where family and friends waited always felt like a long hopeless journey. Yet while this poignant intersection of compassion and mortality is difficult, it is that very compassion, and the humility and caring involved, that drew many of us into healthcare in the first place.

Today, much of that compassion is being stripped away. Early in my career, in the 1970s, we had time to build the kind of personal relationships with our patients that often contributed as much to their health and well-being as the medical treatments we prescribed. Sadly, the space in which to cultivate these deeper relationships seems to be slipping away—lost to an electronic medical record that is as much about billing as about caring, and to an impersonal corporate structure that prioritizes revenue generation over a deeper understanding of the social and economic circumstances that contribute to illness.

I became a doctor to improve people’s health and well-being, not just to treat their medical conditions. I soon realized, however, that in many cases I was treating the medical complications of social problems. I was trained to treat the medical conditions, which I did to the best of my ability; but afterwards, my patients returned to the same social conditions that had brought them into the hospital in the first place. I eventually realized that our healthcare system is designed not to support wellness but rather to profit from illness. While most healthcare providers certainly don’t approach caring for people that way, the underlying business model does.

Serving in public office while still practicing medicine gave me another insight: the realization that the more money we spend on healthcare, the less is available for housing, nutrition, education, or other things that are critical to health and well-being. Since first running for the Oregon legislature in 1978, I have spent 26 years as a representative, as a senator, and as governor trying to develop a new model—one built on the recognition that health is the product of many factors, only one of which is medical care.

In 2012, in the depths of the Great Recession, Oregon established such a model: coordinated care organizations (CCOs) for our Medicaid recipients. The CCOs don’t just treat illness; they cultivate health by addressing not only physical, mental, and dental care but also related needs such as safe housing, transportation, and fresh, affordable food. CCOs have also demonstrated that it is possible to expand coverage and reduce the rate of medical inflation while improving quality and health outcomes. Now, with the deep recession triggered by the coronavirus pandemic, it is time to scale this kind of model up for the whole nation. My primary aim with this article is to offer one way in which we might achieve that goal.

From Cost and Coverage to Value and Health

For decades, the healthcare debate throughout the United States has focused almost entirely on coverage—on how to pay for access to the current system—rather than on health. What is missing is a consideration of value, which in this context means that the purpose of the system is not simply to finance and deliver medical care but rather to improve and maintain health. Indeed, the things that have the greatest impact on health across the lifespan are healthy pregnancies, decent housing, good nutrition, stable families, education, steady jobs with adequate wages, safe communities, and other “social determinants of health”; in contrast, the healthcare system itself plays a relatively minor part.

Ironically, since the cost of medical care consumes 18 per cent of our gross domestic product (GDP), our current healthcare system actually undermines our ability to invest in children, families, housing, economic opportunity, and the many other key social factors important to health and well-being. This is a primary reason why the United States does not compare favourably in terms of health statistics with nations that choose to spend far more on the social determinants and far less on the healthcare system.

If we could reduce our healthcare spending from 18 to 12 percent of GDP (which is the average spent by most other industrialized nations), we would free up over one trillion dollars a year to invest in the things that contribute more to health. Such a reduction in spending might seem impossible, but successful examples of how to bring down the total cost of care do exist, including Oregon’s CCOs. Under these care models, providers receive a global budget to provide quality care with good outcomes for a defined population; if the global budget is exceeded in any given year, the providers are at financial risk for the difference. These care models change the system’s incentives from rewarding sickness to rewarding wellness—and they work. Because they focus on improving health, they prevent illnesses and thereby reduce costs without sacrificing quality.

Effectively addressing the access, value, and cost issues in our healthcare system is one of the most important domestic challenges we face as a nation. Doing so, however, requires both a clear-eyed assessment of what this system has become and the courage to challenge that system. The global pandemic, with its profound economic and social consequences, has brought into clear focus the urgent need for a new model more aligned with caring, compassion, and the goal of improving the health of our nation. And no one is more qualified to lead that effort than the people who have dedicated their lives to the healthcare profession.

COVID-19 and Our Legacy of Inequity

In 1882, the newly formed Populist Party wrote in its platform, “The fruits of the toil of millions are boldly stolen to build up colossal fortunes for a few, unprecedented in the history of mankind.” Now, over 125 years later, these words aptly describe our current social and economic conditions and how little progress we have made in terms of social justice and equal opportunity. The novel coronavirus has exposed anew the inequities and the linked class and race divisions within our society, problems that have been with us since before our nation’s founding, almost always churning just below the surface, visible only indirectly when we examine disparities like disproportionately lagging health and education outcomes for chronically under-resourced— often racially or ethnically segregated—communities. Especially in the past few decades, these inequities have been masked by debt-financed economic growth that has prevented us from mustering the political will and societal solidarity necessary to address them.

Perhaps nothing better illustrates the depth of these disparities, or the extent to which social justice has been eroded, than the US healthcare system. It is a massive corporate enterprise that now consumes nearly one-fifth of our GDP, a huge employer that is increasingly dependent on public debt for its financial stability, and a major driver of income inequality. The pandemic has cast these inequities and contradictions into stark relief.

We see the difficulty nonmedical essential workers have had in obtaining adequate health protections, often resulting in significantly higher rates of infection. These are people in low-wage positions—often with minimal or no sick leave or insurance—working in grocery stores, warehouses, factories, and food and agricultural production sites. We also see that Black Americans are dying from Covid-19 in dramatically disproportionate numbers—deaths attributable to the structural inequities in our society that make Black people and other people of colour more likely to have diabetes, heart disease, and high blood pressure, and to live near major sources of health-endangering pollutants and far from health facilities and grocery stores. These are issues we urgently need to address.

At the same time, the pandemic has for the first time brought the economic interests of those who pay for, consume, and provide healthcare into clear alignment. This gives us a once-in-a-generation opportunity to transform the current system by demanding value as well as universal coverage and by constraining the total cost of care.”

To be continued next week.

 What a Village

After such an above sober analysis…

The votes for the US President have been counted and, as predicted, Trump is behaving as he always has, and in so doing disgracing all American democratic traditions.

Joe Biden has won. I have not thought much of him, but now that he is on the brink of Presidency, he needs his critics – of which I am not even a speck in importance of one of these – to give him a chance.

Trump is exhibiting the sure signs of dementia. People are now openly saying he is lying and the media is by and large turning him off. The pathetic lies are obvious, but is he confabulating? There are these long blanks in his mental processes which he fills with babble. This is associated with early dementia. Therefore, with his face the colour of a tomato, which even make up cannot hide suggests a visit to an independent medical panel would be wise.

Nancy Pelosi is 80; Joe Biden is on the cusp of 78; Mitch McConnell is 78 and unquestionably the most unhealthy seems to be Donald Trump, who is only is 74. He has had a dose of the Virus and refused to heed its danger.  Instead of convalescence he embarked on a frantic schedule in which he encouraged his adoring crowd to gather into a feed lot for the Virus. He demonstrated how the President’s power must be reviewed, as the Senate has done in the past, to clip presidential authority. Trump has shown how susceptible a nation can be to bullying, even when this is limited to four years.

There is an increasing adage that 70 years is the new 50, but believe me, 80 is the new 80. Something happens between 70 and 80 in many people, and that is why it is hard to detect how well they would handle the “next four years”. Retention of physical and mental health in individuals begins to become more of a lottery. Therefore, both Pelosi and McConnell should be watched for any slippage, but in politics that is an inconvenient comment.

I do not fear of being called ageist, because I am in the same age group. Biden still shows he can jog to the President-elect’s podium, but he called upon Obama to assist in maintaining a sense of mental resilience. I had made the comment earlier that Biden would give away to an Obama restoration. I made the comment that this may be stopped in its tracks by Michelle Obama. Obama’s oratory over the last few weeks helped solidify African-American voting intentions in these closing weeks.

Kamala Harris is 56 years old and Mike Pence is 61. Whether having endured years of Trump, Pence might retire in Indiana to try and cure the PTSD engendered by four years at “Don’s Party”, with any thoughts of a future Presidency probably snuffed out. However, the future of Kamala Harris will determine whether that divide in America painted red will ever accept under any circumstances a woman, especially if Biden should die or be incapacitated over the next four years.

In short, there is much that could be added without rehashing that which has already been said. What in the end were the most significant conclusions for me?

  • America elected a woman Vice-President.
  • Trump scored 72 million votes.
  • COVID-19 has affected three per cent of the population and O.8 per cent of the population have died up to this point. Does anybody out of that 72 million in the imitation of a self-obsessed narcissistic ex-President really care about such a small group of “losers”? Is America that callous?

Mouse Whisper

Not Anywhere

            Not Delaware

                          But Somewhere

                                     Wilmington South Australia

The Worshipful Company of South Australian Field Mouse Grain Handlers have asked me to invite you Sir to open the Wilmington Night Rodeo on January 23 next. I understand to perform this important role you will have re-schedule a minor ceremony in Washington to be with us. However how could you afford to miss having the finest tucker at Rusti Kate’s Feed Lot after a trip through the Puppet Museum, which I understand as a fine array of your predecessor’s marionettes.

Respectfully

Wilmington, South Australia

Modest Expectations – Nisi

Today was Melbourne Cup day. You know, the sporting event that stops a nation. Except we have just driven 800 kilometres from   Dubbo to Broken Hill. It is not the first time we have driven between the two cities, but it served as a reminder that going on a long journey with yourselves through the Outback of Australia is a reminder of our diversity. Australia prides itself on its multicultural diversity, but even to my urban eye, Australia also has great climatic diversity.

In the brochures which highlight this diversity there are always pictures of the Great Barrier Reef, tropical rain forests and beaches, Uluru and red deserts, and the Sydney Opera House. However, along a road on a hot day, diversity springs out at you if you care to look.  The subtle changes in the landscape are there. The problem of being the driver is that one drives essentially with a strip of bitumen in front of you. Traffic is increasingly sparse the further you penetrate into the country.

The thin strip of bitumen

Whenever I go on one of these trips, I say to myself that I must learn more about eucalypts. There have been multiple experts who can tell a gum tree variety just by running their eyes up and down the structure. The fragrance of Australia is breaking apart a newly picked gum leaf and smelling it. Describe the smell and you describe Australia as it has been for thousands of years.

Between Dubbo and Nyngan, there are a number of small towns. This is wheat country interspersed with natural habitat.

There is a white blanket along the sides of the road. They are tiny white everlastings that nature has gathered into posy-like clumps and then strewn through the bush.

As the soil becomes drier, everlastings give way to small clumps of salt bush dotting the landscape and foreshadowing that there is saltbush country beyond the horizon.

The scrub varies from open woodland to areas of brigalow, with the grey feathery foliage atop a black trunk, the mallees – greenery close to the ground, then clumps of native cypress, some gidgee trees. These are interspersed with the gum trees I wished I could identify.

I well remember driving from Bourke to Goodooga in the north of NSW and my companions identifying the trees as they would their relatives. The most striking of all of them was the leopard gum. Each of these trees and others reflect microclimates in each of these areas being distinct, which in turn makes the whole landscape such a diverse experience.

On our trail today, animal life is scarce – one emu, no kangaroos, a number of feral goats, no cattle and a small flock of sheep in saltbush as we neared Broken Hill.

After Nyngan it is 130 kilometres to Cobar. At Nyngan, in a unprepossessing iron shed which houses the toilets, we find that rarest of commodity, soap – and something in my wide usage of such facilities I have never seen before – paper towels, all maintained by the volunteer group that run the adjacent wool shearing shed display.

Contrast this with the stop at the MacCulloch Range wayside rest area which boasts a children’s playground, a barbecue and a long-drop toilet without toilet paper – and where the birds are conditioned to congregate around the toilet when occupied, because the outside wash basin discharges its waste water directly on the ground for the birds to drink. Here there are several plaques identifying NSW Ministers who have made the journey to unveil them – one in recognition of the completion of sealing of the road between Nyngan and the South Australian border in 1972 and the other for the creation of the children’s playground and the other facilities there! Talk about turning up for the opening of an envelope – but then the latter was Carl Scully.

However, that stopover is closer to Wilcannia than Cobar, which owes its existence to its copper mines. Then it is 260 kilometres to Wilcannia from Cobar, with no settlements in between.

Wilcannia stone

Wilcannia was once a thriving river port where boats were loaded with the wool clip and sent down the Darling River. The magnificent buildings made from the distinctive Wilcannia stone attest to a past colonial magnificence. I was once shown the quarry from which the Wilcannia stone was extracted. It was disused although stone remained under a cover of bush. The stone makes beautiful cream coloured buildings, so much in synchrony with the intense clear sunlight. Perhaps the quarry has been worked out – but the stone would still attract use for building if that is not the case.

Wilcannia is now an Aboriginal town as it has been all the 30 years since I first stayed and worked there. Here was where I learnt so much about the Barkinji people. Today in 40 degrees heat, parked in a nearly deserted main street, we watched the Melbourne Cup on a laptop.

This year travelling the route was somewhat unusual in that rain had come and turned much of the country green.  The salt bush seemed to coalesce with this greenery. The red earth still broke through, and in particular there were some areas which had not received much rain.

The last kilometres through to Broken Hill pass through a plain almost devoid of trees. While there was a rim of hills in the distance, this land was flat and green – it seemed to be a continuation of the Hay Plains to the South, which are so treeless they give an illusion of a flat earth. It is said these plains are the area which most effectively demonstrate this illusion.

At last Broken Hill nears, we turn our watches back half an hour to South Australian time. Now on all sides we see what many people describe as the engine which made Australia – the huge silver-lead-zinc deposits – after the gold rush petered out. There is no way Broken Hill can be described in one paragraph.  I’ll reserve that for another time since this one day in the Outback stands alone – yet another tincture to colour the wonderful commodity – experience.

Old Broken Hill

The Three Horsemen of Politics 

“To spend a third of life in unproductive idleness seems a dreadful waste to some people, and now and then they decide to shun the slothful practice evermore.  No one has yet succeeded. After a couple of sleepless nights they are as sleepy as anyone else, eventually become incoherent and irrational and seek the season of all natures.”

                  The last six words are stated by Lady MacBeth.

When I listened to the tirade from Minister Frydenberg demonstrating his basic ignorance of what Daniel Andrews had done, I could not believe it – coming from the mouth of someone who in all public demeanour before has shown control albeit behind a quizzical expression.

So what did this outburst signify?  Many applauded him for it. I did not. I thought the content wild and illogical. I have watched politicians over the course of 50 years. Published many years ago in the print media, but seemingly forgotten, I have been jogged to repeat what I said then.

There were three challenges for politicians that I identified.

  • Sleeplessness
  • Isolation
  • Boredom

As I wrote about sleeplessness, it seems to be a badge of honour of some politicians not to sleep. I remember that Margaret Thatcher boasted about how little sleep she needed. She ended up with dementia. When I first wrote about the deleterious effects of lack of sleep, there was not the evidence there is today about its link with Alzheimer’s and Lewy body dementia.

I have always likened sleeping as the time you put out the cerebral garbage.  This image seems to have been validated by scientific evidence. When one does not sleep, then the garbage in the form of amyloid or other toxins is left to accumulate in the brain.

I well remember the experiment of “the tipping cat”. Here the cat would just be allowed to fall asleep and then immediately be tipped up. This was repeated time and again, eventually turning the cat into feline paranoia.

The image of Frydenberg scribbling away and then launching into the tirade made me wonder about how much “good sleep” he is getting. From a forensic point of view it would be interesting to know what he actually scribbled, and the psi impact on the paper hopefully not reflected in the way Trump violates paper with his black signature.

So that is the first question I would ask of Frydenberg. What about your sleep?

Turning to isolation; the figure brooding, looking out the window – the Person Alone – is supposed to indicate strength and a thoughtfulness, the ability to sustain 40 days and nights in the wilderness. However, the reality is that most politicians hate isolation. My thought is that when they all moved to that new Mussolini era-architecturally inspired mausoleum called New Parliament House, to offset the innate isolation of the long corridors and the vast atria with offices designed for excessive space with the consequence of distancing themselves from us plebs, the politicians employed more and more staff. In the Old Parliament House, people lived close to one another, which in itself reduced isolation – apart from which, the place was so small no one could fit a large number of staff.

However, now politicians have to work in a building which structurally promotes isolation enhanced by the ever-increasing levels of security; then, when a pandemic appears, the frailty of those isolated is shown. When isolation is a negotiable commodity, then it can be brushed aside – but when isolation comes with compulsion to save the health of a nation, then it becomes very challenging because it is real, physically.

Because in a pandemic that’s exactly what they should happen -one isolates oneself.

Another problem with isolation is that it breeds ignorance and, when combined with sleeplessness, an inability to adapt. One of the ways to combat this is to listen, not as a public relations exercise, nor one looking for an anecdote to bolster your belief system, but as a genuine effort to discover alternative views. I always remembered the politician who said he went to meetings outside his comfort cocoon, because there was often times one comment or an idea would jolt him from his “cocoon of isolation” and make him think further. Isolation thus has a mental component.

The final component which has grown over the years to feed isolation has been this obsession with security. The activities in the Middle East have fuelled this, together with the increasingly inflammatory comments from politicians revelling in the inferno of populism. When I first entered the political scene, security was not the industry it is today. Even when there was the attempt to assassinate Arthur Caldwell, then the Leader of the Opposition, in 1966 there was no knee jerk response. Security has now become an industry – a commodity – to be traded- and alongside its growth are the vested interests. It is no doubt a contributor to isolation, but how much? One can only say that if one believes it is important to combat “the politician as an isolate” it needs to be factored into any considerations.

Then there is boredom. People believe that hustle and bustle is activity. This boredom was exemplified by the criticism of Mr Albanese’s office. It sounds like a playground with or without a sandpit. The problem is that there is not enough real work for these characters to do. They then just play endless games of “gotcha” in between their sycophantic acknowledgement of their various politician employers.  As I once wrote: “Boredom and its consequences have the effect of pushing away some people who could have been important contributors. It would disastrous if, at the centre of the political world, are solely those who delight in the entrails of boredom, and who actually revel in gossip, ritual and games.”

In the intervening period I have witnessed how true most of this is. There is no reason to believe that Frydenberg ever gets bored, but it is reason for him and others in high places to be aware that boredom breeds mischief – bouncing between venial and venal. Staff members need useful work to do and if that doesn’t exist, you don’t need them.

Therefore, if a government does not have an optimistic agenda demanding substantial policy discussion, hope is rationed and eventually boredom thrives from a lack of hope, because there is nothing to do but obfuscate, let forth tirades and generally be unpleasant. Because there is that ghost of the Cheshire cat and all it conceals, to goad. Then add sleeplessness and isolation and it becomes a toxic mixture!

Paul Collier – Lest we forget

I don’t know whether his name has been mentioned in the Disability Royal Commission. I very clearly remember meeting his mother though.

At the time I was on quixotic mission handing out voting cards at the Woodcroft booth in the seat of Mawson. Dr David Senior, a rural general practitioner friend of mine, was standing on a single issue of saving the Royal Adelaide Hospital, a perfectly good building on North Terrace, rather than have it replaced with an extravaganza further up the road. The new hospital has since been built; it has had huge commissioning problems but is a legacy to that man of impeccable judgement, Mike Rann, then Premier. This judgement was attested to by his chummy relationship with Lance Armstrong.

Then, as now, Mawson has an ALP member. The electorate is a predominantly outer suburban electorate, but also includes a significant slice of the state’s wine industry and now extends to include Kangaroo Island. Woodcroft, where I was handing out cards, was very suburban – wide streets, not many trees, the signature brick veneer homes but not McMansions.

This is where I met Paul Collier’s mother. Collier was a quadriplegic, highly qualified who, at the age of 21 had the accident which rendered him with this severe disability. This had not stopped his advocacy for the disabled and he had formed the Dignity Party. He was on top of the Party ticket for a place in the Upper House, but 11 days prior to the election, he died from a cerebral haemorrhage. His name had remained at the top of the ballot. His votes were passed on to the second person on the ticket, Kelly Vincent, a young woman with cerebral palsy, who was duly elected and served one term, and tellingly was not re-elected in 2018.  The conventional stated reason for this was the change to optional proportional voting. If so, this is an indictment of how the community viewed her candidature, not important enough to either vote for or preference her, disability and all.

But then in March 2010, I shall never forget that extraordinary woman, having just farewelled her son two days before, handing out how-to-vote cards for her dead son’s Party. I did not discuss her motives with her; she was still wrestling with the grief.  She had told me enough.

When I wrote this to Mike Steketee, a journalist I knew well then, I myself was not disabled, as I am now. Once I found out the complexity of being looked after, as I have, I recognise how difficult it all is. Frankly, I don’t know why you need a Disability Royal Commission over four years. What will it tell me in its recommendations about what should be done that I do not already know.

The labour intensity of keeping people alive is huge and thankless; one problem of medical science – from the marginally viable 22-23 weeks pre-term to the centenarian with dementia – is intent on keeping them alive at all cost.  An increasingly number of people recognise, as they do elsewhere, prolongation of life of an obsolete product is about cutting losses – but tell that to the religiously superstitious! It was reported this week that almost 50 per cent of those who have died in aged care in Australia from COVID-19 had dementia.

Society is conditioned to mourn the dead, often a self-conscious piety when it just boils down to how, in personal terms, the dead are just names. We fumble in how we express ourselves when we feel nothing. Going to funerals as a matter of form is not grief. Grief is a solitary situation, and when you lose your mother as a boy, it lives with you for the rest of your life.

Disability has been raked over. Let’s assume the cost is considerable; the modelling light on “how much” flashes “a lot”.  In these times with a government in deficit, if you want to care properly – you need a tax.

Confront the country with the figure for care for a moderately disabled person if treated individually at home or in an institution; then ask each taxpayer individually would they be prepared to pay that tax, given that around every health problem is a shell of fakery and profiteering associated with the privatisation of aged care. The Disability Royal Commission should be able to answer some of the questions underlying the statement in this paragraph.  If they have, then why the need for extension?

Apart from the here and now I faced the dilemma of how to confront disability almost 50 years ago when I was a young doctor responsible for an adult rehabilitation ward. One day in 1971 a 12-year old boy was admitted, paralysed down one side, a spontaneous event without apparent cause.

He was a bright boy and I had immediate empathy with him. I saw him every day. He came from the country, but nobody came to see him. His parents seemingly had disappeared at the onset of his medical condition when the boy was transferred to the city. It is very difficult to be child in a rehabilitation ward where most were elderly. For some reason, it was difficult to discharge him, because facilities for a child soon to become an adolescent with all that meant were poorly differentiated. Adolescent medical care as a specialty was in its early stages.

Thus, for respite on a couple of weekends with the agreement of the hospital, I took him home so he could experience family life.  Our sons were seven and five at the time.

We lived very close to the hospital. My then wife and I contemplated whether we could go further and seek to take over his future care and education. We consulted a range of heath professionals, before initiating anything. We never mentioned it to anyone – we were not adopting “a pet” to be discussed over morning coffee. The question was whether we could give him a better life, not him to be regarded as a trophy.

We both agreed the question was whether we could be both appropriate “foster parents” or “adopted parents”. In the end we were dissuaded; we had to cast off any incipient emotional ties. However, for a period we wondered whether we had done the wrong thing. As it turned out, we probably did the right thing – but how would you know as we did not maintain contact. We did ensure that he would be cared for in the short term and not be forgotten. No Royal Commission could have helped us then or, I suspect, now.

In hindsight, given where we both are now, it was obviously right, but then nobody will ever know what would have happened if he had become part of the family. Dwelling on such matters at an individual level gets one nowhere, except to think that Ron Sackville must have wisdom which the rest of us do not. 

Mouse Whisper

As someone who remembers the toll of the 1980s, this piece from the New York Review of Books is sobering, so much so that if a mouse could shout from the rafters and not squeak, I would say loudly:

There is a terrible fear that the toll on health care workers from COVID will have been in vain if Trump’s failure to effectively tackle the pandemic continues, if testing is not ramped up to levels that allow for identification of carriers and contact tracing, if distribution of protective equipment is not done rationally but rather through nepotism and profiteering, if experts are removed from important positions after questioning incompetent political leadership, and if reopening the economy is done haphazardly to fulfill talking points on cable TV in hopes of gaining re-election. 

Perhaps the greatest lesson we can take from the AIDS epidemic is one that came after the movie star Rock Hudson died, effectively removing the blinders that President Reagan was wearing. Reagan, a friend of Hudson, at last ceded authority to scientists like Fauci, who knew how to speak to the public about illness and create a sense of common cause, and to mobilise both the public and private sectors to triumph over a virus that had never been seen before and many believed could not be effectively combated.  AIDS arrived as a murderer; now it can be shackled. We are nowhere near that point with COVID-19.

Modest Expectations – Orwell

Orwell wrote this book in the year the reverse of 1984 – 1948.

Orwell’s book “Homage to Catalonia” is the one of the best books I’ve ever read. Orwell otherwise was a miserable person – perspicacious but miserable. “The Clergyman’s Daughter” typifies his style of claustrophobic writing.

1984 was not that sort of year.  I cannot forget any day in April when the clock struck thirteen.

It was just another normal year of people being beastly to one another. Afghanistan was already the definition of insolvability. Reagan won, Hawke won, Essendon Football Club won – in that ascending order of importance for me.

The year started with my being in India. I started my particular passage to India a few days before New Year when I had flown into Bombay at a time before it changed its name to Mumbai. The overwhelming sensation was how crowded the airport was. I was going on to Delhi and learnt not to make any assumptions about that country.

I had assumed that I would be going to Delhi where I would be staying before going on to Lucknow for The Indian Medical Organisation Conference, which was held from 28 December each year. The assumption I made was that I would be flying domestically as my ticket said Air India.

When I negotiated my passage to the domestic airport, I was informed there that I was flying on an international flight, which went from the international terminal. Yes, it was destined to fly to Delhi, but then on to Moscow and then Manchester. Thus, I had to retrace my passage back to the international airport. It was night; the weather could have been better, but it had the effect of accelerating my acclimatisation to the subcontinental idiosyncrasies.

I don’t remember very much about my flight except they had both piroshki and vodka on the flight and there was more than a sprinkling of Russian speakers.

The hotel in Delhi, when I reached it, in the early morning was adequate, about two stars in modern day classification. The second lesson I had learnt by the time I arrived at Lucknow was to go with the flow. The Conference organisers had booked my accommodation, which was more in the “fallen star category”. I took one look, did not unpack and moved at my own expense to Clark’s, which was then the best available hotel in Lucknow.

Yet I did take time to visit the site of the Black Hole.

In India, there were times you could play the “sahib” card but that was not one of them. The learning curve was to prove steep. From wondering why the hell I was there, over a month I came to love India. Nevertheless, it took me almost 40 years to return. I had a number of excuses, but underneath, I just didn’t want to be disappointed that second time around. Frankly, on return to Australia I basked in the raised eyebrows and the questioning faces when I told them where I had been. I suppose they believed India to be the repository of Westerners in beads, sandals and designer rags. I did not fit the bill; moreover, I should have said I loathed it.

After all, had not India undone the Beatles? The film of E.M. Forster’s Passage to India was released later in 1984, and I confess I spent too much of the time watching this luxuriantly filmed epic trying to identify the scenic backdrop.

Lucknow

In Lucknow the most memorable occasion was a conversation with a Brahmin doctor and his attitude. He both knew Indira Gandhi and hated her to the extent of saying that she should be killed. She too was a Brahmin and here I was in Uttar Pradesh, their home territory; among the fragrant roses of Lucknow, I listened to his tirade. Every time I tried to steer the conversation onto the Indian health service, he brought me back to the Prime Minister and her faults as he saw them.

Whether he was serious or not, it was a prescient exchange. On October 31 later that year she was assassinated by her Sikh guards, apparently as a revenge for the attacks she ordered on Amritsar earlier in the year. The reprisals following her assassination saw 20,000 Sikhs killed.

Sitting in the wintry sunshine in Lucknow, I did not realise the extent of the anti-Indira undercurrent. However, while I was in Lucknow, meanwhile my partner who had come separately was fending off the marauders in Madras, barricading her hotel room. That was her welcome to India. Then later there was the delay getting from Madras to Delhi, where there was a complete lack of information about her flight details, until when I was just about to lose the plot, she appeared.

Yet after all the tumult, it was a great month for us, travelling as far north as Simla and as far south as Nagercoil. India has this overpowering diversity. We travelled in all classes on various trains, save on the roof. The overriding lesson with a wry smile – best to go in pairs, one to create the space, the other to watch the bags. Really a commentary on life rather than just on India. 

An American Nightmare

This is the last week of the campaign and the lesser of two Halloween warlocks is leading the polls. Yes, the plagiarist, promoter of Clarence Thomas to the Supreme Court by his disgraceful prejudiced handling of Anita Hall’s evidence in the leadup to the Thomas confirmation, his touchy-feely approach to women verging on the gropey, and the almost complete vacuity of his machine politician mind behind the smile.

And yet if I were American, I would vote for Biden.

Trump is unhinged (as I have said before) and his periods of lucidity are becoming fewer and fewer. However, there is enough commentary and associated evidence to show he is totally unfit for government for me to need to say anything more.

There was a theory among the leading business people in the early thirties in Germany that they could control the Austrian house painter. They were so wrong, except that many of them a dozen years later climbed out of the wreckage of Germany to consolidate their fortunes post-war.

However, the hopes of the side are probably those Republicans behind the Lincoln project. They are prepared to sacrifice a Republican President for Biden knowing that the latter won’t do much beyond trying to bring the country together. It will be the difficult task after the Trump dislocation, and the Lincoln Guys doubt whether Biden has the fortitude. They know him well given that he has being hanging around Capitol Hill for over forty years. He as President, essentially if he fumbles, may give the Lincoln Republicans time to find a suitable Republican in their own image.

Trump will build a militia if given a second term either directly or by way of the National Guard. His operatives have already penetrated police forces, who have been able to obtain military style weapons by confected fear being whipped up against the unseen – cynically “a fear of the darkie”. When he has done that, Trump will be able to dump the rag tag bearded motorcyclists draped in confederate uniforms. They are the equivalent of the Nazi “Brown shirts” – and when the Brown Shirts were seen as an undisciplined nuisance, they were cowered in the Night of the Long Knives – and this American bunch do not have the leadership quality of an Ernst Roehm.

They also realise that Trump will continue to stack the judiciary, so it becomes an extension of himself – lackeys without any regard for the separation of powers. Even before that is done if faced with a hostile Congress, he will endeavour to cower this remnant of democracy – and burning of the Reichstag provides the play book. That is the horrific scenario if transferred to the White House burning down.

Biden on the other hand, should he win in a spirit of unity and solidarity, may appoint “Lincoln Republicans” to his Cabinet. Then there is always the fact that, at the end of his term, should he win the next election, President Biden will be 86. As such, re-election in 2024 would put him into Mugabe territory in relation to age. However, well before that his mental capacity will be under close scrutiny. COVID-19 has been a blessing for him because it has given him the opportunity of a low – almost subterranean – profile and to conceal the wisps of that.

Nevertheless, when the expectations are low, then breaking the mould and actually doing something positive is liable to be received more rapturously rather than if his profile had higher expectation. This is exemplified by the visceral hatred in Middle America towards the Clintons, who had come into office with high expectations. One never wants fallen idols, especially if shown to be hypocritical. Cupidity, among many other Clinton failings, does not work well in communities that prize thriftiness and hard work.

Trump has never been the Fallen Idol because he has skirted the problem of us mere mortals bound by a set of Commandments. He has been deified by his followers and just like the pagan gods he has freed himself of any moral restraints. He has created his own reality where his sins are just an accepted part of the framework of his Reality.

Next week it will be interesting whether this Reality comes back to Earth, and as with the gods he is transmogrified into a beast, bird or plant – hopefully not the Lyre Bird.

The Return to the City

One rule I have always had is to try to live close to the hospital, health service, department or office where I worked. At the start of my career and at the end of my career I spent a considerable time away from home. However, even in those jobs, my accommodation was close to work.

The times I have driven against the morning and afternoon traffic; and wondered if the “trade off” of living in suburbia would be worth it. For years the conventional wisdom has been that you herd the workers into the centre of the city, but nobody had factored in the bloody mindedness of it all. Sit in a car for an hour plus and then at the end of the day, sit for another hour to return.

The first response to the above comment is to say that I have been lucky to be afforded the luxury of not having to travel far to work.

Nevertheless, living once in a rat infested flat where the final decision to leave was because of the staircase had been converted into a waterfall when it rained, because of a repeated failure by the landlord to fix the roof, was hardly an example of inner urban luxury. However, that flat was close to work. Admittedly I do not cope well when sitting in traffic, and that problem has become more acute with age.

The solution has always been to avoid the peak hour period, which is extending as congestion not only with automobile traffic but also with public transport increases.

My first year of being an intern in Box Hill hospital meant separation from my then wife, who went home to her family to prepare for our first child; my second postgraduate year saw me in Geelong, employed at the hospital and commuting which was not easy, but at least I didn’t have to drive through endless traffic.

Even though I have led a nomadic existence, I have avoided that relentless, repetitive, endless and ultimately soul-destroying life in the urban gridlock or on public transport.

COVID-19 has taught society two lessons. The first is hygiene. Before this virus, many people with upper respiratory infections would turn up in the workplace ensuring the spread of, in most cases the virus – colds and influenza were accepted as part of the fabric of modern life. This is the first year that so far I have been clear of “the dreaded lurgie”.  Once I contract an upper respiratory tract infection (URTI) it means four weeks at least of the virus giving me a belting.  I still have a residual cough from my last attack in 2017.

In the pre-COVID-19 era, did we use sanitisers? No. Did we even wash our hands regularly? Perhaps. In this last category, health professionals were no better than any other.  My wife, who has always used hand sanitiser and washed her hands, is a constant reminder of my failings!

In the public setting, appearing to have a respiratory infection with associated coughing, sneezing and spluttering has become as socially unacceptable as smoking. The spectre of lockdown should dampen any recidivism.

This then leads to the second lesson – the workplace. Somewhat naively I prepared a list in a blog, which pre-supposed an ultimate return to the previous CBD workplace, admittedly sanitised but tellingly through the perspective of the boss. As the pandemic extended, more and more have adapted to working from home, even though this has meant career impinging on domesticity.

People are adapting to this so-called remote workplace. The technology improving connectivity effectively supports remote working. Travelling into the city for language lessons has given way to Zoom at home. There has not been any alteration in the learning process, just finding a parking space in a part of the city where even over a year increasing restrictions are so evident. Not having to worry about that is a relief and reduces the need and the stress of travel.

The problem for employers who are wanting their workforce to return is that many employees have adapted to working from home, now that technology is making it more than feasible and, whether it is genuine or a convenience, they ‘may not feel safe returning to work’. The resistance and the measures use to abort this social change will be interesting, because the so-called Big End of town (Culo grande) of town has been resisted.

The problem is that when there are unpalatable, unexpected changes: for instance, big investment in palatial offices so there is need for opera glasses when you enter the chief executive officer’s office, the board room with a view where the cabinets overflow with expensive alcohol and butler service, and those cosily expensive nearby city restaurants where you can avoid hoi-polloi, all the time being chauffeured around to avoid the CBD bustle. Is that reason enough for a return to the old pre-COVID-19 order?

Having written this, it is important to say what others will not because they fear reprisals for bringing out into the open the arrogant and selfish element of business, as described above and which has been accentuated by their integrity stumble.  The rise of the rent-seeker class with associated dodgy practices does not like the disappearance of the CBD – not that it will stop pressure on government to bail them out.

Already you have the governmental business advisers led by Mr Powers wanting to convert the CBD into quarantine facilities – and then at what price!

There are probably other very legitimate reasons for calls for a return to the CBD. These are not restricted to the owners of such properties, where the medium term future is challenged. I am sceptical of the NSW Treasurer, who has presided over a litany of alleged corruption, appearing to coerce workers back into the CBD. No reason, just coercion. However, it would be ironic if a so-called free market government would adopt a “soviet” approach to look after their mates, especially given the track record of his Department in coercing workers to return to the CBD.

Many of the reasons for such a return advanced in a recent forum on return to the “old order” seem illogical – as though just herding people into a large office building will stimulate the economy.   No, it is a very threadbare plea smacking of self-interest in the absence of evidence.

One businessman at the same forum said,

My single biggest asset – and it’s daylight between this and the second biggest asset – is my people, and if we push people beyond where they’re comfortable going, we’ll lose people,” he said

‘There was logic to calls for people to return to CBD offices but in the technology space he was up against companies that had told their staff they can work from home forever.

“So, the moment I say you have to come to the office, that is a condition of employment and it’s five days a week, I’m actually at a competitive disadvantage for talent.

This speaker is the type of person whose future ingenuity in enticing people to work for him should be tracked. Will this chap abandon the CBD or not?

Creation of incentives to entice a return to the CBD may not be dissimilar to policy initiatives trying to entice health professionals to rural areas. It may behove those who want people back in the CBD to look at what has and has not worked in ensuring people obey what some elements of government policy say should work. Perhaps somebody should ask Barnaby Joyce about the success of his dragooning of public servants to the Armidale or was it Tamworth CBD?  His was a centrifugal piece of government indulgence; whereas it seems that centripetal forces to the CBD are now more fashionable.

As for Monsieur Perrottet, the Treasurer of NSW and member for Epping, 24 kilometres from the CBD, may seek comment from his constituents on compulsion, government by dominican fiat and his gaudy use of public money.

ABCQ – Morris of Muttaburra

I was impressed by the reported comment of the ABC’s Director News, Analysis & Investigations, Gaven Morris. Central Queensland should be a focus of the ABC’s attention, he opined, rather than just concentrating on the needs of the inner urban elites, who apparently are all lefties like Mr V’landys to name one of my neighbours. He definitely is “elite” and “inner urban” but I doubt a “leftie”. Maybe I am now “inner urban” but not leftie enough to drink Bollinger out of a Fabian Society mug and definitely not “elite. So who are the object of the Morris criticism?

Muttaburrasaurus

Assuming Mr Morris can be a man of precision, he would be talking of Muttaburra – the geographical centre of Queensland and, being seriously thought of by the Queensland Premier, should she survive tomorrow, as altering the emblem of that State.  Muttaburra after all is the home of the Muttaburra Dinosaur – and how appealing, a dinosaur lodging at the centre of Queensland as its emblem.

Muttaburra is a little north of Longreach, where we spent a very pleasant evening among the “outer urban elite” congregated at the Longreach Club, some time ago, before it was burnt down. I have marvelled at the nearby Jericho where all the major streets are named after scientists; Aramac is where they had a lock on the rugby trophy because of their New Zealand shearers; and Barcaldine, the crucible of  the AWU where, under the famous ghost gum – the Tree of Knowledge – the shearers’ strike was hatched; the tree had not yet been so cruelly poisoned.

Now what is this audience you are trying to attract from these disparate community, Mr Morris? After all, Landline is a magnificent reconciliation for those of us in your inner urban bubble. Then “Back Roads” has been a popular social commentary of life in country towns.  It is a pity you have not shared the same sort of delights I have experienced in your Central Queensland away from the coastal fringe.

Take the gem fields near the appropriately named town of Emerald. After a meeting there, I have stayed once in nearby Sapphire, where I spent the night in the nursing post because that was the only accommodation available. The next morning I was woken up by the senior nurse’s partner, who then proceeded to drink a bottle of milk – about half of which was whisky – presumably to ward off the DTs.

Having had dinner the previous night at Rubyvale in a log hut defined as a restaurant, and then later that morning undertaking a tour of the gem fields, it was all a distinct experience. In Rubyvale we were enveloped in a cone of silence until it was realised we were there with a trusted local. This led me to be invited to experience sapphire mining firsthand. I remembered being lowered in what was narrow tin can with one of the sides cut away. I did not measure the depth, but it was probably ten to fifteen feet – maybe more.  Just hold onto the rope was the call from above. Down in the mine there was just an empty tunnel, not even a mining pick in sight.

Later I roamed the bush to places called Divine and Tomahawk, white fella gunyahs where the fossickers would vanish. Incongruously there was a public telephone at Divine. I learnt one of the local wardens had had his thumb blasted off  there by one of “Australia’s 10 Most Wanted”. They said the warden later went mad, but maybe I was confusing wardens.

Like everything in these gem fields, (around Sapphire there is no opal), but in opal fields outside Queensland – Lightning Ridge, in particular, Andamooka, and White Cliffs, (Coober Pedy I have yet to visit and Quilpie I have written about before in this blog) it is best to accept people as you see them and not to ask questions. Just go with the flow, accept the apocryphal and listen to the ABC and thus make Mr Morris happy.

Mouse Whisper 

I happened to be in Yorkshire when Hitler re-occupied the Rhineland. Hitler, Locarno, Fascism and the threat of war aroused hardly a flicker of interest locally, but the decision of the Football Association to stop publishing the fixtures in advance flung all Yorkshire into a storm of fury.

George Orwell – Road to Wigan Pier 1937.

Sound familiar? Publishing the football fixtures was important for gambling, centred as that was around the Pools in pre-war Great Britain.

The Road to Wigan Pier

Modest Expectations – The Hawke has Landed

After managing the responses to the Christchurch terrorist attacks, the White Island volcano and a pandemic — not to mention the birth of her first child — (Jacinda Ardern) has become a global standard-bearer for a progressive politics that defines itself as compassionate and competent in crisis.

So spoke the New York Times after Jacinda Ahern’s landslide election win last Saturday. Let’s face it, she was a refreshing breeze at a time when there had been some dodgy females hogging the headlines in Australia.  I get sick and tired of the mantra that women do not get a fair go. These women have demonstrated that they are no different from men. The one qualification is that I have never seen women politicians flogging stuff out of their parliamentary office. However, Darryl Maguire is not on his pat as a male if the species in running a two-dollar store out of his parliamentary office

The current problem is that having convenient attacks of amnesia seems to be the most valued commodity in public life whether it be female or male.

In my first blog, which I wrote 83 weeks ago before all that was recounted above occurred, I wrote: “Yet Jacinda Ardern gives me hope. Her words – her demeanour of grace, compassion, resolve, her ability to call out the bully – the courage of making herself a target for all the “unspeakables”. She is indeed a paragon.”

However, there is a squad of chaps who do not like her. I was criticised for blind adoration. Yet one of her great assets is a supportive partner, a person with presumably “selective” adoration.

The brutality of politics is reflected in that her hapless opponent was nick-named “Crusher”, and yet the woman seemed to revel in being called that.

Now the New Zealand election is out of the way, there is the opportunity for our horse-drawn politicians to recognise – as the rest of the world has done – what a contemporary and significant stateswoman she is. She has been the equivalent of a wartime leader in her approach to disasters which would have defeated a lesser person.

The laughable attacks on her last week by an alleged apologist for the Australian security service and the political remnant of Mary Knoll makes one ashamed to admit to the same nationality as those other elderly jokers.

Now, Ardern can get down to work to try and transfer her qualities into the deeply corrupt Australian society. I thought I would never say that we could ever learn from a Kiwi.

As one commentator has written, the liquidity has caused a surge in real estate market prices in New Zealand, particularly Auckland.  Hopefully, this will encourage her to abandon the KiwiBuild scheme, which seems to be a remnant of “Rogernomics”, and spend the money directly on much-needed social housing.

Improved contact, whatever you call it, with Australia is also essential. How the two countries deal with the South Pacific and the incursions from the Northern Hemisphere countries will be a critical test. However, before that there will be wool.

All that superficial crap highlighting tearful family reunions around “the bubble” hides the fact, which I noticed driving around NSW this week, that there are a lot of sheep that need to be shorn. With a shortfall in our shearing workforce, Australia needs shearers. The shortfall is generally made up by 500 New Zealand shearers. Until the TransTasman bubble was developed in the last couple of weeks, there was a deterrent in the high price New Zealand shearers had to pay for working in Australia, with their own fares and quarantine arrangements estimated at A$10,000.

A gun shearer can earn $150,000 in Australia if they average 200 sheep a day. New Zealand shearers are considered high quality and readily employed by shearing contractors so it should be attractive for them to work in Australia, especially now they are able to enter Australia freely.

Let’s hope that we adapt now to developing a better collective arrangement, instead of a perpetual Bledisloe Cup attitude between the two countries. It is time in the aftermath of COVID-19 to lay down our scrums and get to work. I am sure Ardern is up for the challenge. Not sure about the Australian Prime Minister, but then November 3 may change him – or not.

It Could be a Lot of Rot

There is extensive fruit and vegetable picking work available in Australia. The Australian Bureau of Statistics estimates about 140,000 people are employed in this industry every year. In fact, many people travel the country working the ‘harvest trail’ which sees them in employment all year round. This is because they know when and where the harvests are and move from one harvest to the next.  

For many years, I worked in North-east Victoria right in the heart of the orchards and fruit picking. I witnessed changes in the industry during my time.

There is no doubt one of the most tranquil moments is walking along the lines of pear and apple tree with the emerging fruit. There is a calmness in the ordered lines of greenery and the rilled earth and grass along which you walk.

It was sad to see the tree pulling, which left that Acadian stroll of my first years an empty paddock.

During that time there were changes in the industry. The rise of the farmers’ market meant that there was a new appreciation of fresh fruit. The decline of canned fruit as a major component of the Australian diet meant that apricots had already fallen out of favour with the orchardists before I arrived there. The cling peaches beloved of the canners are far from being the best eating variety.

The then chair of the local health service came from a line of orchardists and the family enterprise was a major economic driver in the town, together with tourism and the now defunct milk processor. His view of the workforce was that he had the itinerant pickers who worked from harvest to harvest. They came year after year – fruit picking generally commenced in November with cherries and apricots, but the major fruit were first, the stone fruit – nectarines and peaches followed by pears and apples until late April to early May.

This was a separate cohort from those employed to pick grapes as the region is a substantial wine producer with the grape picking reaching a peak in February.

My expert friend was not particularly positive about backpackers, because they would come and leave after a few days. The problem is that the media generally turn up on day one rather than, say, day 70 to photograph the “happy campers”. The attrition rate was high, he said. The orchardists need a steady work force not a group of young people flitting from place to place.

When I was young I myself did a variety of vacation jobs – working in a wool store, reading electric light meters, working as a storeman, a guard on armoured cars, gardening, pathology laboratory assistant, working as a clerk among first and second war veterans in the then Repatriation department, spotlight worker. There may be others that I forget, but I know I never went fruit picking, which I regret.

One of the strengths of working in these jobs is you learned the vernacular of being an Australian worker, essentially at a time when unionism was strong. This was important when you were a doctor and your patients were essentially working class, as those of my father were.

There is a growing complexity in the horticultural industry, because one business model does not necessarily encompass the whole of horticultural harvesting.

Some politicians who undertook compulsory national service (or more likely received an exemption) in a different era now champion putting “these young blighters” to work in some sort of revived “Nasho”. However, there will be some smart young person, who will see a place for a scheme which harnesses the workforce in the gig economy to perform this kind of work.  Yet the politicians have allowed a generation of young workers to be pushed into the gig economy, whether they wanted to be there or not, and now may be the time for those in the gig economy to organise themselves – they have the means to do so.

It is a fallacy to believe that the young are not entrepreneurs.

Given the appropriate incentives they could develop business models for efficient fruit picking or for that matter the whole area of horticulture.

In forming the business plan, there are a number of hurdles to address. How do you marshal a workforce with tertiary aspirations, yet where the vacation coincides in substantial part with the fruit-picking season; and yet where the delights of the flesh and the necessity to work are in conflict.

Fruit picking as a business exercise should not be left to the labour contract companies, which the COVID-19 pandemic has shown to be both predatory and incompetent.

Fruit picking as a youthful enterprise, with the instincts of a co-operative work force, requires consideration in that balance between government subsidy and impost on one’s future career. Therefore, the business must ask the question of how much and whether in the end it fills the gap between the two.

The female and male workforce, price, availability, reliability, capacity needs to be assessed and negotiated. In the end are there enough young people prepared to pick fruit effectively and efficiently?

There are a number of reservations, and that is the sustainability of the industry, and because it is so varied and seasonal to develop the flexibility. I remember my orchardist friend pulled a substantial number of trees and replaced them with freezing storage units, because there was a significant demand for such facilities. That was business.

Tastes change.

When I was young, one of the treats was having snow apples. They grew in cold climates and I last had them about 15 years ago; they were growing in a vineyard in the Victorian Pyrenees. Once grown commercially, they suffered from a lack of reliability and resilience, which gave them a short season and besides, they did not store well.

For the growers, profitability is aided if the need for manual harvesting is removed. One industry which has completely removed the need for manual labour is the sugar cane industry. That has occurred in my lifetime.

Almond Trees

As another instance, the number of almond trees that have appeared where once there was only a dried fruit industry along the Murray river has meant that with the rise of the almond and with mechanisation of their harvesting there is no need for a labour force. Similarly, just outside Leeton there is huge acreage being given over to walnut trees. Again, no manual harvesting.  It highlights the need for a workforce that is both agile and responsive.

I know if I were younger and had lived in a “horticulture”, I may have tackled this task, but I am not. Still, it is a challenge because, as I said, tastes change. I remember when I was reviewing a small health service on the Victorian border, I innocently mentioned that I was growing pomegranates. The response I elicited was somewhat comical. The man was about to invest in “serious” pomegranate tree planting. It was a time when Australia had just discovered the delights of the pomegranate, and he immediately thought I was there to “case” the place for pomegranate investment rather than reviewing the health service. When I said I was only planting a couple in my back garden in Sydney, he visibly relaxed.

As an epilogue, pomegranates must be removed from the tree using clippers or secateurs, from March to May. The stem of the tree is strong and thick; fruit cannot be pulled from the tree without damaging the fruit and/or tree. There are no mechanical harvesters. Some of the growers have small acreage and have banded together to form de facto co-operatives to avoid employing pickers. However, as the southern hemisphere only supplies one per cent of the world’s production, the potential should be large for out-of-season export to the northern hemisphere. Ramping up production will require a workforce to pick the pomegranates as they are not the easiest to harvest.

Over to you guys.

մոգ pronounced mog

Armenia

Armenians, it was once said to me, are the shrewdest business people after the Bengalis. Armenians can weave beautiful intricate carpets. Armenians have been Turkish punching bags. Armenians, if nothing else, are survivors. One of my favourite songs is linked to that great Armenian troubadour Charles Aznavour. The song? “She”.

She, Gladys Berejiklian, also has strong and proud Armenian heritage, clear in the retention of her surname. She has cultivated an image of saintliness trying to emulate the many Armenian saints within the Armenian Orthodox Church that as reported she attends regularly.

My encounter with Gladys was when she was the newly-elected member for Willoughby. She came to a dinner where I was the guest of honour. She was late and was brought along by the host of the dinner to be introduced to me. Before that could occur, she saw somebody who must have been so important that she was totally discourteous and totally ignored me, despite being brought to specifically meet me.

I was surprised but then the Italian have a word for it –menefregismo. The barista not looking at you as he pushes the coffee in your direction while talking to a mate at the bar is an example. When it is combined with furbo, which has many interpretations but suggests a person on the make, then it perfectly described Berekjikian that night – except she is a furba to acknowledge her gender. After all – fare la furba – is to jump the queue.

Despite that first impression, if I thought about her which was not often in the intervening period, she seemed superficially to be assiduous and competent.

This year, however, you could not get away from her, because of the series of incidents. I noticed a characteristic, which underpins her authority. She can talk for long periods without saying: “um” or “ah” or any hint of hesitation. It was a trait that I remember a certain English teacher trying to instil into us boys, and for years, there was a BBC radio show called “Just a Minute” where the panellists were given a subject and had to talk for a minute without hesitation, repetition – a variation of not saying “um or “ah”.

It became clear that even when she was very wrong, as with the Ruby Princess, this ability to talk without hesitation gave her an air of authority and her escape hatch from admitting error.

It is amazing how a one trick pony has gone so far, but it may be argued when coupled with that of her immaculate conceived persona that she has been very important to her Party when underneath her feet is a swamp of indeterminate depth inhabited by all sorts of creatures, those that grate and those that appal.

The immaculate sparkle has gone. Yet one of her Ministers, in a stumbling defence, said she was married to NSW. Needless to say, how that could be interpreted in the current soap opera obviously escaped him.

At least, NSW has been spared that agonisingly ambiguous statement of the politician under stress: “I am going nowhere.”

I await the first hint of hesitation in her voice, but maybe that occurred with Kyle Sandilands. Then some may be said to have standards which do not include parsing his utterances and her replies.

I have to admit she did sign the gift I received at the dinner and still treasure – a magnificent book on Aboriginal Art.

Chloroquine studies are alive and well in Parkville

There is still one study in Australia into whether taking hydroxychloroquine can help prevent health care workers getting COVID-19 in the first place. And the jury is still out on that one.

What an interesting take by the intrepid Paul Barry. He had spent extensive time in his “Media Watch” two weeks ago bagging that comedy duo, Bolt and Dean, for their advocacy of the use of hydroxychloroquine in the treatment of COVID-19.

I expressed concerns months ago that funding had been provided to the Walter and Eliza Hall Institute of Medical Research (WEHI) to test the prophylactic use of this drug for health workers. The hypothesis I thought threadbare, and subsequently, the evidence against its use has become overwhelming. Barry interviewed Steven Tong from The Doherty Institute who had stopped a trial on the drug’s usage, and used the word “rubbish” in defining the further investigation in the use of the drug.

Even Donald Trump has disavowed its usage, and Barry played an excerpt of recent footage of the President to back up that contention.

So why his curious form of words suggesting that health workers are a separate entity, otherwise why in Barry’s words is the jury out, when he had just demonstrated that the jury had well and truly delivered the verdict of it having not only no effect but also potentially dangerous.

I sent an email to Mr Barry, but he seems to have learnt from his usual quarry of spivs. Just ignore and hope I would go away. However, over my long life in which I have been exposed to many journalists – their worse outcome is to lose objectivity and begin to be believe in their self-beatification.

For the record, I’ve published below my last letter to WEHI, after I had a very swift response to my first letter. Note that I have had no response in the interim 3 months plus, when much has happened to further discredit the use of the drug.

The problem is this drug can potentially kill, for what? WEHI had assembled a cheer squad asserting the worthiness of this study. I was assured that the funding was totally derived from government, although WEHI had admitted accepting money for COVID-19 from a Chinese company, which has been under governmental investigation for business malfeasance.

I made sure that copies of my correspondence were sent to both Brendan Murphy and Anne Kelso, the Chief Executive Officer (CEO) of NHMRC. Needless to say, they have shown no interest.

I have published that letter, unabridged below. I hope that community and peer pressure will stop this pointless exercise. I canvassed the study with certain sources outside the WEHI claque, and one comment was telling – how concerned he was in the decay of a once great Institute. Not my view as yet.

Perhaps, Mr Barry, you could clarify further why you made that comment, when you were so definite in criticising it elsewhere in you program. Have you an undeclared link with WEHI? Unfortunately I don’t have my own “Media Watch” to keep you up to the mark.

I’m sorry, but at this stage, I am disappointed. Below, my last letter of 27 June 2020 to Prof Doug Hilton AO, Director, WEHI:

Dear Professor Hilton,

Thank you for your very prompt email. Your direct response in relation to the source of funding for the study is instructional for those who obfuscate, however unintentional.

I am very sympathetic to the plight of research institutions in raising funds, but raising expectations, as you would realise, is two-edged. I am somewhat concerned by some of the reports emanating about putative cures because there is already a scepticism in the community about science, which has led the dark fringes of society exploiting anti-science attitudes in the community. This situation is always aggravated when expectations fall short.

You are very disappointed by my linking the Trump support for hydroxychloroquine, but the message received is as equally important as that sent. I do not question that Pellegrini and Wicks had constructed a hypothesis, but its construction when there is already controversy as to its use obviously raises question of whether the publicity created did not play a part in the government making available funding.

I’m alarmed, as you must be, by the apparent renewed support by Trump for its usage even after the FDA’s July warning on its safe use, on the advice provided by Dr Stella Immanuel, whose other ideas are bizarre to give the most generous interpretation. Given how increasingly difficult the situation is becoming you may wish to reconsider the WEHI position, given any association with this Dr Immanuel’s idea would not benefit WEHI.

It is for you as Director to determine its priority in the overall research program if MRFF funding had not been made available. That the availability of funding was not influenced by political considerations, at the time when hydroxychloroquine as a cure was being so widely promoted, was at the tie partially answered in your response.

I note that the study is subject to interim analysis and look forward to its release.

I note that the study has rheumatologists and other lines of support, I am not sure whether my requests have been answered so that I am not personally reassured, in particular concerning the safety of the study. However, for the time being I shall accept your assurances.

In relation to your final paragraph, I have read your annual reports and periodic bulletins – and I understand you have had some spectacular results that have resulted in profitable collaboration with the private sector. However, may I make a couple of points: you refer to my being a medical doctor, but I also suffer from a chronic autoimmune disease, and therefore mine is not a detached interest.

Also in relation to the therapeutic effect of hydroxychloroquine, as I have written elsewhere, the drug was essential in treating the malaria that I contracted in Madagascar over 30 years ago. It was a nasty experience; fortunately I have never had a second attack. But that was malaria, a recognised use for hydroxychloroquine!

From your response you are far from the “the simple protein chemist” as you describe yourself. Your response is impeccably drafted, apart from your use of “principle”. My principal committee I assure you was principled.

My kind regards

Jack Best

As someone said, the first death of a health worker in this study will see a scattering of support for the study, which would test even the best “Outback ringer” to catch.

Watch this space.

Mouse Whisper

Hickory Dickory Dock

The way he kisses dictators’ butts. I mean, the way he ignores the Uighurs, our literal concentration camps in Xinjiang. Right now, he hasn’t lifted a finger on behalf of the Hong-Kongers,”.

“The United States now regularly sells out our allies under his leadership, the way he treats women, spends like a drunken sailor. The ways I criticize President Obama for that kind of spending; I’ve criticized President Trump for as well. He mocks evangelicals behind closed doors. His family has treated the presidency like a business opportunity. He’s flirted with white supremacists.” …

“But the reality is that the President careened from curb to curb. First, he ignored Covid. And then he went into full economic shutdown mode. He was the one who said 10 to 14 days of shutdown would fix this. And that was always wrong. I mean, and so I don’t think the way he’s led through Covid has been reasonable or responsible, or right.”

The author of these statements?  Senator Bernie Sanders? Any other Democrat?

No, it was the junior Republican senator for Nebraska, the anti-abortion, anti-Affordable Care Act, pro-gun, anti-impeachment Senator Bill Sasse.

Yes, he may have said it in a whisper, but let me say it was a courageous whisper across the Pawnee National Grasslands of Nebraska.

Senator Bill Sasse

Modest Expectations – David Owen and Norman Cowper

For those who want to follow the sordid details of the former Member for Wagga Wagga, Mr Darryl Maguire’s shenanigans while he was a Liberal Party member of the NSW Parliament there is plenty in the media about his questioning before the ICAC that I need not repeat, including his close relationship with the Premier.

However, when his conduct forced his resignation from Parliament, at the 2018 by-election, Joe McGirr was elected. Joe was then easily re-elected at the 2019 poll. Joe is an Independent, and first challenged Maguire in 2011 with his major policy to upgrade the local hospital. He achieved a swing against the entrenched member Maguire who was, at that stage, the Liberal Party Whip; the miasma had yet to rise and cloud his parliamentary career.  Joe had not stood in 2015.

Joe McGirr

Joe McGirr has a strong ALP connection and his great-uncle was Premier of NSW. His grandfather was Minister of Health in NSW when James Dooley was Premier. Joe is resolutely independent and has resisted blandishments to join any Party.

Joe McGirr came to Wagga Wagga as a junior doctor and remained there, undertaking a number of roles. He is married to Kerin Fielding, the first female orthopaedic surgeon in NSW (and only the third in Australia in what is very much a male club). They have four adult children.

Dr Fielding is a cordon bleu cook, and she and Joe have a retreat in the south of France, which unfortunately I have not savoured.

Over a period of time I have had contact with Joe, as I undertook a number of jobs in Wagga Wagga, and I encountered him from the time he was a young doctor on the way up. During the time when the first rural clinical school was being planned in Albury and Wagga Wagga, which had its moments because of the traditional rivalry between the two cities, Joe was always eager to assist. It was unsurprising when he became Associate Dean of the then new Notre Dame Medical School.

Joe has been reported as saying that: “My views on social justice were formed by the Jesuits during my education, with the Jesuit approach linking justice to action and love. I have seen through my work, many areas of rural disadvantage that create problems for the whole of society as well as those directly affected. Social justice is an important part of our medical program and should be a part of every doctors calling.”

This view on social justice has been translated across into his diligence in parliamentary life.

With Joe, you know what you’ll get.  Brutally honest, in a sea where there so much parliamentary squalor, just look at whom he replaced. A premier swain, no less – and high on the Dodge.

The problem with anybody who runs as an independent for parliament in a country electorate, it helps if you have local “cred”; for Joe it counted for a little at the first tilt, but not enough.

He persisted.

When I have advocated for an Integrity Party, sometimes you wonder if you talking to an empty stadium. However, Joe McGirr is a very useful role model for future candidates, even if he is an avowed Independent.

Oh, by the way, his first major electoral policy has been accomplished.  And there is more – the local Wagga Wagga hospital has reached stage 3 of its redevelopment.

A Casual Comment which the Conservatives will probably ignore – for the time being

Barry Goldwater

In 1995, Barry Goldwater warned the GOP that they would rue the day they welcomed the religious right into the party.

It is a pity it took him until he was 85 years old to say that.

However, maybe an Australian somebody of a similar age in the appropriate part of the Australian spectrum will have the guts to say that – because in the end ignoring the Goldwater axiom will savage the credibility of genuine conservatives.

David Owen visits

In 1982, the Australian Institute of Political Science (AIPS) reached its fiftieth anniversary. The Institute published the Australian Quarterly and held annual Summer Schools where people from all sides of the political spectrum used to gather to mingle socially and discuss matters politic.

The pioneering Cowper Family crest

Norman Cowper was one of the founders of the Institute. Of the pioneer families five – the Cowpers (arrived 1809), the Streets (1822), the Stephens (1824), the Windeyers (1828) and the Fairfaxes (1838) have produced representatives, prominent in public life, over the succeeding four or five generations.

Thus Norman Cowper, a lawyer in one of the biggest Sydney law firms, was hardly a radical. However, in the 1930s he was very concerned with the rise of fascism, as he was of communism. In founding the AIPS in 1932, he saw it as a bastion for the political centre where the reasonable left and right could converse across the policy divide. Therefore, the Board and contributors represented both sides of the political spectrum – then United Australia Party and the Australian Labor Party. Gough Whitlam used the Summer School to test some of his policies in the years running up to the 1972 election.

While the AIPS was Sydney-centric, it had a Melbourne Committee. However, it was not until I moved to Sydney that I was asked to join the AIPS Board. The Institute survived on modest grants from some of the large companies and the proceeds of the Summer School. However, by the 1980s as politics became more ideologically driven and coverage of politics in the media expanded, the influence of the AIPS began to decline.

Although we did not know it at the time, the fiftieth celebration was the last hurrah for the bipartisan flavour that the Institute had attempted to inject into public debate. I was entrusted with organising the anniversary.

Norman Cowper was 86 at the time, and everybody wanted him to be there. The family was enthusiastic and so it was important that the anniversary honoured him. However, I had the disadvantage of being a newcomer to the Board, essentially an outsider who had to work around the sensitivity of a Board that had known better times. The sun was setting on what the Institute had been constructed to be, a bulwark against the extremes in politics.

David Owen

At the time of the celebration it was before the Falklands war, Thatcher was on the nose and Reagan was still to make his impact. I thought that it would be an idea to have speakers from each of the decades. David Owen, as co-founder of the newly-created Social Democratic Party, provided a model of the centre. He was a doctor, and he was friendly with a prominent English surgeon who I had met the previous year. I was able to enlist his support in having David Owen accept the invitation.

Unlike speakers today, David Owen did not charge for his attendance and through my contacts, a first-class airfare was arranged gratis; that left the Institute to pay for his accommodation.

I had the idea of having a relevant speaker for each of the decades from the foundation of the AIPS to describe what was happening in terms of the politics and policy.

The speakers were Nugget Coombs, Bill Snedden, John Button, Anne Summers and Patrick Cook, with Max Walsh as the Master of Ceremonies. The talks, including the inaugural Cowper Oration given by David Owen, were scattered across the dinner which was held at the University of Sydney.

In addition, I persuaded the guys at Movietone, who had their archives in Balmain at the time, to put together a traditional newsreel, together with the highlights of 50 years. So it was a jampacked evening. Anne Summers was a great help in getting the program together, particularly persuading Nuggets Coombs to reminisce on the 30s and Patrick Cook to round up the speakers’ list.

I remember asking Paul Keating whether he would attend, but anybody – no matter who they were who deserted the Labor Party – was a “rat”. David Owen had been elected as Labor Party member for Plymouth Devonport and was part of the “Gang of Four” that had broken away from the Labor Party in 1981, and at the time of the Oration he was very much the flavour.

We were both doctors. We spent an interesting week together, and he told me that he had not had a better “minder”, but I said I had done it before – and had learnt a great deal about being the essential shadow. He gave me one piece of advice which has been imprinted in my memory ever since – never be caught in the soggy political centre.

I’m not sure whether he followed his own advice.  My view is that the centre is not definable; it shifts around like the Magnetic Poles.

Later I was to become the Chair of the AIPS and suffered an attack from the right to take it over. This time, the Centre proved not to be soggy, and the attack from the Victorian right was defeated. I learnt a lesson – if you naively believe that a centrist political position has a future you need resilience and deep pockets – and wait until the stench from the political miasma becomes too much, even for the most complacent, and the community pleads for a climate change.

Re-setting the cuckoo clock

Guest Blogger:  Janine Sargeant AM Master of Public Health

“No general penalty, pecuniary or otherwise, shall be inflicted upon the population on account of the acts of individuals for which they cannot be regarded as jointly and severally responsible.” So says the 1949 Geneva Convention.

No wonder Victorians, and Melburnians in particular, are sick of both lockdowns and being treated as pariahs judging by the statements from the smaller States. This is particularly the case for the border communities. NSW fares little better when it comes to treatment by these other states, but at least has avoided the harsh Melbourne lockdown. Yes, group punishment is alive and well here in “good ol’ democratic Australia”.

Premier Palaszczuk is the stand-out serial offender here. Anxious to present herself to her electorate as the defender of Queensland against the “marauding plague” from the south, her offensive comments about locked down Melburnians have just added to their misery.

When the Queensland border opens up to the plague-ridden southerners they could be forgiven for rejecting her blandishments to come and spend their hard-earned money in this Mendicant State of the North. Opening day: likely to be just after the election. Surprise; surprise. The fact that her fellow Queenslander, Pauline Hanson is the prime practitioner of xenophobia, she as the inheritor of the Barcaldine tradition should be bloody well ashamed of following the Hanson line. The Deputy Premier, Stephen Miles has exhibited arrogance verging on boorishness in his contempt for the southerners.

Palaszczuk and Miles shouldn’t underestimate the extent to which their endless ill-considered commentary about not wanting those “diseased” southerners in Queensland has made the past three months even worse (apart from the purveyors of football games and others she has exempted). Don’t underestimate the impact of the longest, toughest shutdown in the world on the mental health of those in its midst.

And what is the latest advice from those who apparently encouraged hoarding of food to combat the swine flu epidemic? There is a rumour about gunships on the Brisbane River to repel invaders from the south although this one is difficult to confirm.

28 days of no community acquired cases and then, after a couple of weeks, NSW has three cases of unknown origin, 48 hours to find the origin or else!  Or else what?

Queensland re-sets its cuckoo clock on the border re-opening. Now it seems it is community transmission of unknown origin; talk about moving the AFL goalposts.

The current outbreak in Shepparton again demonstrates the challenges this country is facing, particularly when individuals think guidelines don’t apply to them.  It highlights again that public health in every state must have strong contact tracing and clear directions in relation to targeted testing and expanded self-isolation. There is no excuse for this not to be the case; the health departments have had months to get this right. Contact tracing will allow all states to keep outbreaks suppressed – and there will be outbreaks.

But not to cynically use disease for a blatantly political exercise.

Thus, memo to you Premier (for the moment) Palaszczuk – having no COVID cases when your State is hermetically sealed doesn’t get you any prize; the real test is when the country opens up, which it must do. So, where is the agreed national plan to safely open Australia’s open borders in which you are participating? Where is the plan for affordable quarantine to bring business travellers and tourists back? Or do you plan to lock out the world until it can demonstrate 28 days without community transmission?  Good luck with that one.

Memo to those other Premiers, Gutwein, Marshall and McGowan, read the memo to Palaszczuk and take a memo yourselves; the fact that you might be keeping your borders closed, or you dream up bizarre rules like the current one about not lingering in Mildura for petrol or taking a comfort stop at the side of the road as you drive through from NSW to SA (via the main road at the north west of Victoria) if you want to avoid 14 days quarantine, your actions are seriously dividing a country that is struggling and needs to be pulling together.

A bit of advice to the fiefdoms, look up “mendicant state” and remember that Australia is one economy but the larger State economies support the smaller ones. It is about time the Prime Minister rounds up the Premiers and directs some mature thought about Australia behaving like an adult nation – not a collection of infants in the playpen they rule for the moment.

Bud Wiser

Driving along we had just crossed the Lachlan River on the road through Darby Falls, beyond a line of trees there it was in a field behind a gate sardonically labelled “Railway Crossing.”

It was a Budd railcar – still recognisable – a silver cigar-shaped carriage sitting out in the middle of this field.

In 1950, the first of three Budd diesel powered rail cars was bought by Commonwealth Railways for use in the Iron triangle of South Australia.  I remember being on one of its first trips between Port Pirie and Port Augusta. For a young boy, this gleaming motor train with its rippling silver stainless steel frame shouted “I’m American” and resembled the Pullman cars that were featured in American films and magazines at the time, albeit without a locomotive. It was very exciting. I almost thought I would see a man in a peaked cap and appropriate livery there to assist us onto the car. In the American films of the time they were always black men. This was well before Afro-American replaced the subservient descriptions of the slave state.

Three rail cars were shipped to South Australia, manufactured by the Budd Rail Company in Philadelphia. The rail cars were said to be able to attain speeds of 90 mph, and I remember that day in May 1951 climbing aboard, and finding myself hit by cold air. Air conditioning is taken as a given in today’s world, but not in 1951.

There were two compartments, originally with the luxury of padded seating for forty-nine and forty-one respectively, buffet facilities being fitted still enabled 70 people to be accommodated.

The reason I was on this train was that it was the link service which enabled us to join the “Ghan”, the train originally named after Afghan camel drivers that worked across the Territory. The train travelled between Port Augusta and Alice Springs. The contrast between the slick Budd railcar and the venerable steam train labelled the “Ghan” was amazing as though one was climbing back into a past century. In those days, the “Ghan” wended its way through the Flinders Ranges and then North through the desert, but through that part of the Simpson desert which was liable to flash flooding.

The rail cars because they were swift and relatively noiseless and ran on the unfenced railway also had a propensity of striking wildlife, in particular kangaroos.  Twice on level crossings the rail car tangled with trucks, and on one of these occasions the rail car driver was killed.

Four of the cars were built under licence in Australia for NSW railways later, but by the 1990s all the rail cars had been retired.

One obviously ended up on this property, but it only shows there is always something around to remind you that you have been on this planet far too long.

Roger Dunn

He was my oldest friend, but our pathways deviated far away from one another. It was in the past few years when these now old men re-started the relationship we had at school. Some of the magic which is deep friendship remained. Roger was a successful scriptwriter for shows like Bellbird, The Sullivans, Homicide. He was a great watcher of human frailty, even though probably a bit too much was seen through the bottom of a wine glass.

He was not a bad artist and learnt part of his trade from John Brack who, for a time, was our art teacher. The ever-alert Roger noted that Brack had a separate room into which he would vanish, often with a young lady; in the romantic parlance of Dunn at the time this room was dedicated to our teacher’s trysts. I was too naïve to notice. After all, ours was a boys’ school.

Anyway, Brack found time to do a pen and ink caricature of Roger which now has pride of place at the school.

I penned this piece below which Roger’s eldest son, Lachlan read at his funeral last week.

Name?

Roger McLeod Dunn, Sir

Two small boys stand forever captured in navy blue shorts and butcher blue shirts, unbuttoned blazers; but not forgetting the cap on head. From home to school and cheering events, the cap jammed on head was the essential ingredient for everyday living.

Two small boys living close to the same railway line. Trains thundering past – a mutual lifeline to wild distant lands of Kooyong, Darling and Jordanville.

Two small boys joined by their love of words. Once they both entered a competition at school – one with delicate touch described the feathery fairy penguin; the other wrote about the awkward grumpy cassowary. The boy with the light touch won, the youngest ever winner of that prize.

The two boys endured that school; had a friendship held together by that love of literature where even in daytime they both could see the stars.

Vale good friend. The fairy penguins will be dancing with you.

And you? John Barton Best, Sir.

Mouse Whisper

The guy from Old Man Gunyah Creek said as the vehicle passed by the hill, the afternoon sun casting a sheen on its purplish-blue colour: “You know,” gesturing towards the hill, “It is always a matter of perspective. Some call it the Riverina bluebell, while others – Paterson’s curse.”

Having been in England in early spring where bluebells dot the country often in the dappled shade of trees with their new foliage, it is a sight immortalised on many a painted teacup. From a distance, you might gain a similar impression as you drive through the Australian countryside, especially where the weed may be seen growing in gullies shaded by gum trees.

Obviously, Jane Paterson thought so when she bought cuttings back from Blighty in the 1880s to plant in her garden on the family property. She did not think it a weed.

Then the weed escaped. Mrs Paterson’s name is not recorded among our female pioneer heroines.

For Australian farmers who have experienced the spread through much of the East Coast and Tasmania, it is Paterson’s curse. It can be used as fodder, by animals with a rumen, but it caused consternation by those driving by when they saw a number of horses in a large patch seemingly feeding on it. It can kill horses.

However, as a footnote there is a suggestion it was not her fault -well not totally. The number of phenotypes found here are greater than found in Blighty; but sorry that does not let her off the hook.

Somebody had to be the first. Oh, I remember it is success which has many authors, but then I remember – the weed has another name. Salvation Jane.

Jane, Paterson or Bluebell

Modest Expectations – Telephone Pole on Ardmona

Fillet of a fenny snake;
In the cauldron boil and bake;
Eye of newt and toe of frog,
Wool of bat and tongue of dog,
Adder's fork and blind-worm’s sting,
Lizard's leg and howlet's wing,
For a charm of powerful trouble,
Like a hell-broth boil and bubble.

I must be living in a parallel universe.  Nobody has commented how much like Wonderland it all is. Illness with Trump becomes a circus act.

Two lines of people in white coats troop down the stairs of the Walter Reed Hospital. In my many years I have never seen doctors emerge from a hospital as if they are members of a marching band who have forgotten their high stepping band major twirling a baton.

At that stage, I wondered who was looking after the President – he was conducting a photo-op to convince everybody he was working; yet he looked ill. So, I presume the crew of that little masterpiece he was filming were physicians who doubled as camera crew.

Then he is out on the streets, denying every protocol relating to the Virus, bar one, he appeared to have his lower face covered. But he is a bag of contagion, for God’s sake.  He is being driven by men in masks and white coats, but the strait jacket is nowhere to be seen.

Back in the hospital, he has a tantrum. “I wanna go home” is the insistent refrain. Back at the White House, it is plain that he is short of breath, struggling to maintain his posture. Next frame in this farce: Trump has seized the narrative from his medical staff and is now reporting his own condition. The cameras do not switch to the White House lawns to show his staff playing croquet with flamingos as mallets with Virus balls.

The head of Trump’s medical retinue is an osteopath. Sure he was titled an emergency physician, but what does that mean in the term of this guy’s experience? He demonstrated a level of inexperience, which could be attributed to nervousness or incompetence.  As has been observed, “There are innumerable examples of sycophants rising to a level of incompetence where they are finally ‘revealed’. When that happens, the kissing up no longer matters – now reality demands competence.”

The question remains: what does his osteopath know about infectious diseases? Not much.

The President is being given a weird concoction of drugs, and one of the ironies is that if this unpredictable infant negotiates the illness, then the cult worship will intensify.

Is Trump taking a calculated risk in leaving hospital and returning to the White Burrow, whilst ensuring a screen of twitters? Or have the hinges completely come away from the door?

Zigzagging all across the landscape, he knows that the media are fascinated by his serpentine movements. The media is the helpless rodent in front of the snake, mesmerised by these movements.  Perhaps more the Komodo dragon rather than snake, given that saliva is the medium for contagion, and that saliva is an ooze coating his White Burrow. So beware the Kiss of the Komodo, Ivanka.

But then young Komodos climb trees to get away from the cannibalistic adult Komodo – they, like Donald, are too heavy to climb trees.

And as a postscript question to the hapless Dr Conley, can the King Komodo still smell the hamburger and chips he is gobbling?  Or would that be too much like being a clinician to answer that? 

A future President of the USA writes to the incumbent…

It is ostensibly January 31, 1829. Martin Van Buren picks up his quill in New York and writes to President Jackson. He is alarmed. 

“The canal system of this country is being threatened by the spread of a new form of transportation known as ‘railroads’. The federal government must preserve the canals for the following reasons:

One. If canal boats are supplanted by ‘railroads’, serious unemployment will result. Captains, cooks, drivers, hostlers, repairmen and lock tenders will be left without means of livelihood, not to mention the numerous farmers now employed in growing hay for the horses.

Two. Boat builders would suffer, and towline, whip and harness makers would be left destitute.

Three. Canal boats are absolutely essential to the defense of the United States. In the event of the expected trouble with England, the Erie Canal would be the only means by which we could ever move the supplies so vital to waging modern war.

As you may well know, Mr. President,’railroad’ carriages are pulled at the enormous speed of fifteen miles per hour by ‘engines’ which, in addition to endangering life and limb of passengers, roar and snort their way through the countryside, setting fire to crops, scaring the livestock and frightening women and children. The Almighty certainly never intended that people should travel at such breakneck speed.”

The problem with the letter was that it was a (in Trumpian Capitals) HOAX. Jackson had yet to be sworn in when the letter was purportedly written and no original of this letter has ever been found. Yet this example of absurdly protectionist fears, written in such a manner that it would be greeted by outrage and derision, is still given currency.  I remember hearing about the supposed letter when I was a teenager. It had been shown to me in all seriousness. I was duped. This hoax letter is still doing the rounds. How many are still duped?

I wonder whether any of the Trump sputacchiere will have currency in 200 years from now. But then, as those reading about the climate hoax on the parchment of the Murdoch past, it just may be a remnant of civilisation living in a world resembling the remains of a Texan barbecue in an ocean of blue-green algae learning to love aloes, hemlock and bitter melon by then.

An Australian Centre for Disease Control Thought Bubble

A mate of mine received this ALP splurge from the Shadow Minister of Health Bowen.

Australia went into COVID-19 unprepared. We are the only OECD country without a Centre for Disease Control. Our nation went into the coronavirus pandemic with less than one mask for every Australian in the National Medical Stockpile, an overreliance on global supply chains, and badly stretched aged and health care systems.

Future pandemics are a certainty and we can’t be left playing catch-up again. We can’t afford another Ruby Princess, or another tragic disaster in aged care. Our health, our lives and our economy depend on us getting our response to future pandemics right.

That’s why this morning, Anthony Albanese and I announced that, if elected, a future Labor Government will strengthen Australia’s response to future pandemics by establishing an Australian Centre for Disease Control.

Establishing an Australian Centre for Disease Control would mean that Australia will be better prepared to avoid the mistakes we’ve seen from this government so far.

This is one of the most contestable announcements that has emerged from the Opposition. I always remember one Government staffer deriding Opposition policies as “Policy by Penguin Book”. In other words, somebody thinks he has a bright idea, and then reads stuff which supports his claim without discussing it with anyone with experience for confirmation of the assertions.

What the ALP are advocating is that Australia centralise the public health to one centre, as the Centres for Disease Control (CDC) in the USA which, over the years because of good leadership up until Trump interfered with its succession planning, enabled its high academic reputation to be maintained. Now the CDC lies wounded, maybe mortally. There is no back up.

The media release says Australia went into the COVID-19 pandemic unprepared. Yet theoretically perched on a board of an international organisation dedicated to epidemic preparedness was a former head of the Federal Department of Health. This person watched while a number of abortive epidemics denoted by colourful acronyms rolled across our country.

What did she do not only heading Health but also then Finance? Emulated Sir Humphrey, if her performance on the “4 Corners” program was any guide. The “4 Corners” program seemingly was supposed to remind everybody of her grasp of the subject but instead showed how content-free she actually is.

There was no significant increase in the funding for public health under her stewardship and, at the end of her reign as the Government might have said, “we were shovel-ready to cop the Virus”.

However not to be diverted, back to the ALP announcement. Nothing wrong with that first sentence! This writer plunges on.

However, how are the OECD countries travelling? The media release says that Australia is the only OECD country out of 36 members without a Centre for Disease Control. That is a stretch. I am unaware of New Zealand having such a centre. USA with its CDC has 7.3 million COVID-19 cases, whereas the Australian total without a CDC is 27,200 and New Zealand 1,858. How does the author regard the use of the particular statistic to bolster his case for an Australian CDC?

Then the non-sequiter in the release – “few masks, an over-reliance of supply chains and a vulnerable aged care sector”. So? That is not a responsibility of a CDC.

The success of the Australian health system, despite being starved of funds for public health over the past 20 years, coinciding as it did with the Halton stewardship, was that NSW had set up a decentralised contact tracing system in the early 1990s as part of a generalised devolution of public health responsibility regionally. Hence in NSW, disasters in nursing homes and the Ruby Princess were resolved, messily but nevertheless resolved without huge numbers of cases and deaths compared to the later Victorian experience.

Even though I advocated that in NSW heads should roll because of these disasters, the basic strength of the public health system saved them. The Premier has never fully acknowledged the authors of that program – and it was certainly not Dr Chant, as she has herself acknowledged.

The Parkville Precinct

Victoria on the other hand never had an organised public health system, and the reason was that public health funding, beyond the training programs, was sacrificed on the altar of Parkville aggrandisement.

The result was that Victoria was completely ill-prepared to be able to handle the contact tracing requirements of this epidemic. What has saved Victoria is not some esoteric centre in Canberra, but a realisation by Andrews and some of the public health specialists that something had to be done to save the situation. Let’s face it – he closed down Victoria to allow the public health system to be upgraded and a de facto regional approach created.

By shutting Victoria down he enabled the street fighting with the virus to be undertaken with minimum street casualties, and the hand-to-hand combat in nursing homes where the Virus had sheltered to be contained and then has been steadily rooting it out, even though innocent people unfortunately have been caught in the “crossfire” without any protection.

A regionalised public health system has many heads and, unlike in America where CDC relevance and responsibility has been decapitated, thus is harder to destroy.

Ergo, mark for Master Bowen: D-…  A poorly thought-out essay.  Please resubmit after getting advice from somebody who knows.

Appointment with a Telegraph Pole

I was badly injured. Yet as the car which I had been driving a few minutes previously was being incinerated, I found myself laughing. I had got out of the car. I remember releasing my seatbelt and opening the door. Now I was watching the car – a rented Holden Calais burning. In the distance but coming closer I could hear bells ringing.

Charon and the River Styx

Then blank. The next picture imprinted on my memory was of opening my eyes and looking upwards into a hairy face. I did not care, if this was introduction to a hirsute Hell then so be it.

Then I heard my name being called – distant but distinct. Since I was not wearing glasses as I usually did, I had to focus. No, it was not the representative from Hades customs seeing if I was bringing anything illegal to burn, but my cousin’s son Owen.

My cousin, Margaret, and her husband Bill, lived in Shepparton at the time, and that evening I had intended to go to her 50th birthday party there. Bill was the city engineer at the time. Owen had a sister, Jill, who I do not remember playing any role in the drama.

It had been an ordinary Saturday, and I had had an uproarious lunch, with a few drinks. I assessed myself able to drive the three hours to Shepparton. The problem being June, the weather was foul, but I arrived in Shepparton at about five o’clock in the evening. Given that the party was not going to start until after eight, instead of going to the motel, I decided to go and see another mate who had a parish in a nearby town. No matter that this was the eve of the shortest day of the year and the sun had set. The rain had come again.

I did not get far, and fleetingly remembered the car aquaplaning and sliding off the road up a narrow muddy pathway.

So much for any more festivities.

Then blackness before the image of fumbling for the door handle.

Having got out of the car, I could not walk for two weeks. While I had considerable soft tissue damage, the only fracture was a rib broken by the seatbelt as I went from 100 kph to zero in a second or so.

It took me a long time to recover so I could return to work. I needed plastic surgery on my face, where my chin had imploded on the steering wheel. Fortunately, that was skilfully done, but then if you need plastic surgery for disfigurement rather than vanity, Melbourne has traditionally been the best place in Australia. So I was fortunate in more ways than one.

Now 40 years later I have extensive osteoarthritis in spine, knees and shoulders. That is the price of the impact. It is unsurprising that until I developed an autoimmune disease related to the arthritis, I coped. In the years after the accident I competed in many misnamed “fun runs”, and while finishing in the ruck, it convinced me that I had enough mobility to do so.

That I have described elsewhere.

There was one major change that I noticed about six months after the accident, but have I never talked much about it.  Probably because it is so subjective. As background, I had extensive head injuries, and the area between skull surface and the thin muscle layer, the galeal aponeurosis, was a lake of blood. This fluctuant spongy mass stayed for several weeks, but I did not have any intracranial bleeding.

I went back to work. The Italians call it garbo – it is an untranslatable Italian word, but it is the way I was treated – trying to suggest I had come back prematurely but not telling me directly; garbo. Courteous pitying, you might translate it.

My insight was such that I was oblivious to hints for a longer time in convalescence. I was never sat down by my peers and specifically challenged – and even if I had been there is always someone prepared to make allowances, and in split decisions, the benefit of the doubt generally prevails. I presume that occurred in my case, and I solved the problem by being perceived as eventually returning to “normal”.

Yet there was one  change in my personality that, unless you had followed me as a boy, adolescent and young man, you may have missed.  Before the accident, I had been prone to periods of dark depression; yet not despairing enough to be suicidal.

After that head injury, I have never again had these episodes of deep depression. At that time, there was not the same attention being paid to head injury – particularly on the sporting field.

Yet there is now an increasing reportage of traumatic injury of combat, although it has been around since Cain punched Abel.

Having mental infirmity was just a hidden phenomenon, and in an era of “stiff upper lips” as the shorthand for not showing any weakness, you did not talk about mental frailty. If you were laid out, you shook your head, got back on your feet and went back into the fray. There was never any talk about head injury, unless there was obvious loss of function.

In my case, whatever happened to my brain circuits in the crash, I emerged with a change of which I gradually became aware. I was able to cope better with setbacks. The dark moods were largely gone. Had the accident changed my circuitry? The obvious answer subjectively was “yes”. However, there was no one able to judge whether I had changed.

I am not advocating for people to improve their lot by banging their heads against walls, but what I am saying is traumatic injury is very much a lottery, and never should be ignored. Concussion is one thing, but is important in having someone who is able to detect any long-term change from head trauma, especially repeated. The problem is it takes time (and in this world who has the time or the level of care) to stop the episode ending up as a death against a telephone pole on a country road in the middle of a tempest. Some survive; some do not.

Putting Meaning into ExHume

Conditions not complied with or enforced (currently under review). State government approval conditions require 80% of ‘reservoir gas’ emissions (3.4-4 million tonnes each year) from the Gorgon facility to be captured and pumped underground (geosequestration or CCS) delivering a 40% reduction in the project’s total emissions.

Chevron received $60m in federal funding for the geosequestration project. It announced geosequestration had begun on August 8th, 2019, more than two years after production commenced. Delays were due to ‘ongoing technical problems’ and Chevron has also been accused of deliberately mismanaging the geosequestration project. No penalties were imposed by the WA government for emissions not sequestered over this period, and alternative offsets were not provided by Chevron despite State conditions requiring them in the event the geosequestration is not successful.

A review is currently underway by the WA Environmental Protection Authority to examine and clarify the intended start-date for the geosequestration condition at the request of the WA Minister for the Environment. There is no federal requirement for sequestration ….

Chevron geosequestration project

Australia has had a Carbon Capture and Storage Development Fund since 2009. These carbon technologies are supposed to trap the carbon dioxide produced by factories or fossil fuel power plants before they are emitted into the atmosphere where they contribute to global heating.

Once trapped, the greenhouse gas can then be piped into permanent underground storage facilities or sold to buyers who can use the carbon to manufacture plastics, boost greenhouse crops and as one boosting media release said even “help make fizzy drinks”.

As one insider has written, when the Australian fund was established for carbon capture in 2009, crude oil prices were just recovering from a sharp but very brief decline. Then Chevron decided on the final investment decision (FID) for Gorgon. The world was awash in natural gas then as it is now. Chevron made a decision on a projected $30bn LNG facility with a cost model in which high hydrocarbon prices would bail them out.

The cost overruns made Gorgon the most expensive LNG facility per unit cost ever of more than $50bn and the raw gas stream from the field already contains 15% CO2.

Today, carbon capture (CCUS) facilities around the world are capturing more than 35 million tonnes of CO2 per year. Apparently that is equivalent to the annual CO2 emissions of Ireland, whatever relevance that may be. Recent announcements and commitments have the potential to more than double current global CO2 capture capacity. But the International Energy Agency’s Sustainable Development Scenario, which charts a path towards achieving the world’s stated climate ambitions, calls for a 20-fold increase in annual CO2 capture rates from power and industrial facilities in the next decade.

Most activity seems to be taking place in Norway and the adjoining fields in the North Sea. Norway built the first large scale carbon-capture project at the Sleipner gas field in 1996, and since has been storing nearly 1 million metric tons of CO2 each year.

Against the above estimated optimal requirements, that seems small, and Norway is where carbon capture is reckoned to be the most advanced. The current situation is a long way away from the ideal, and despite government investment in the technology,

For someone trying to find out what is going on, the area is full of obfuscation. The quote from the WA Conservation Council at the head of this blog segment has not been denied. The problem is that Government uses “carbon capture” in its recent policy announcement as though it is being shown to be a settled solution. There is one facility in Australia where carbon capture is supposed to work. It is a long way away from scrutiny – the Gorgon LNG project on Barrow Island in the middle of a nature reserve.

At least one matter is to be settled and that is that this natural gas field contributes more carbon pollution than any other facility in Australia.  In addition, the fate of the Gorgon CCUS plant has been racked with problems and even now it is not fully operational while the parent Chevron facility spews out pollution.

So there is a price. Now if the technology is going somewhere, fine, but if it is just a disguised handout to help a business mate or mates, then it should classify as assisting new technologies

It is difficult to work out how much has been wasted as distinct from being spent wisely. The Morrison government has indicated it will contribute another $50 million into carbon capture and storage technology, following more than $1 billion in taxpayer subsidies and investment from the fossil fuel sector since the early 2000s. Teasing out how much has been contributed by either sector may provide a different figure but in the end, we mug punters foot the bill. For what?

Back in Canberra, there is a major structural problem in policy direction, and that is the country is run by a public relations man. He is spin, not substance. It has been an unfortunate trait in Australia in recent times that major political roles have been filled by people of his ilk – journalists – more interested in feeding the news cycle than doing anything to improve the lives of Australians and more generally the world.

NSW suffered from Carr; South Austalia from Rann and Australia, Abbott – although the Abbott is more an aberration and thus harder to classify as a giornalista. Wistfully we may look back when journalists who became Prime Ministers were men of substance – John Curtin and Alfred Deakin.

Added to this mix is Minister Angus Taylor who leaves a dubious trail of politics mixed with self-interest rather than any real commitment to what is one of the greatest challenges – climate change. Frankly, he is not up to the challenge. That is why I suggest that the Minister, the member of Hume should exit, lending himself to a slogan – Taylor to ExHume. In fact, he should be dismissed – no longer be in any equation.

If carbon capture was the only energy boondoggle, perhaps I would be less vehement…but it is not!

I worry about a country where policy is predicated on being generous to your mates. Still, there is always a day of reckoning.

Finally, a pertinent comment from an insider made in relation to those executives in the oil and gas industry, who form a Praetorian Guard of Mates around the Prime Minister:

“They are stuck in their ways, which worked for the past decades and made them and their shareholders very rich. Now they can’t do anything else.

According to API the average age of an employee in the oil and gas industry is 51 years, only surpassed by the average age of employees in funeral homes. The average age of the managers and decision makers in the industry is even higher. 

Right there lies the problem, in plain sight for everyone to see. The decision makers in O&G are all solid, hard-working and amply educated individuals. Sternly conservative due to a lifelong paradigm of analogous thinking such as ‘proven design’ in this once wonderful adventurous industry.”

In ten years, the current lot will mostly be dead, dripping with honours and never having to pay the price they may have inflicted. So shall I be, but is not going to deter me from encouraging Australia to sleep only when the moon is no longer red with pollution.

Mouse Whisper

The Lewis chessmen are about my size. I sat in the back stalls watching a program on this extraordinary cache of figurines, which was a Viking hoard found in the sand dunes of the Outer Hebridean Isle of Lewis in 1831. Most of the 93 artifacts are in the British or Scottish National Museums. When the hoard was deposited, the Outer Hebrides were colonised by Norwegian Vikings.

The figurine which attracted my attention was one of a Bishop, with his right hand administering benediction. With the thumb opened, in the early church, the three open digits came to represent the Trinity (The Father, Son, and Holy Spirit), while the two closed digits represented the dual nature of Christ as both man and God.

However, the Bishop’s hand in one of the figurines resembled Duputyrens contracture, which is a disease predominantly of the palmar fascia, the connective tissue beneath the skin which, as it thickens, pulls the fingers into a flexed position. The disease generally affects the little and ring fingers first.

Further, it is a disease which originated in the Vikings, it is a disease which affects males and is associated – among other things – with a love of alcoholic beverages.

Just an observation, but an interesting one?

Modest Expectations – Spitzbergen

It is high time for me to put an end to your sitting in this place, which you have dishonored by your contempt of all virtue, and defiled by your practice of every vice. 

Ye are a factious crew, and enemies to all good government.

Ye are a pack of mercenary wretches, and would like Esau sell your country for a mess of pottage, and like Judas betray your God for a few pieces of money.

Is there a single virtue now remaining amongst you? Is there one vice you do not possess?

Oliver Cromwell on getting rid of the Rump Parliament

Cromwell

In the first weeks of working for Bill Snedden in 1973, I remember the office in Canberra was visited by a delegation of Myall Lakes’ miners. At the time, Myall Lakes was a major source of mineral sands, the source of the then new wonder metal – titanium. They were concerned with the intention to close the mining. It seemed genuine and that they were not proxies for the mine owners since they had a union representative with them.

In their minds there was no consideration of the need to preserve the beaches and dunes that constituted part of the landscape. It was understandably all about their jobs, a familiar theme. A very relevant theme now that there is an intention to close some coal mines in the region.

Hawks Nest

I knew about the Myall Lakes at close quarters because a decade later, after the mining had been closed down, I and three others walked the colourfully named trail between Mungo Brush and Hawks Nest. It was a very varied walk through coastal rainforest before emerging upon dunes and then back into scrubland and wetlands. It was a superb if challenging walk, the last part of which was through a marsh where there were supposed to be blocks of wood forming a boardwalk. This had collapsed in places and we were forced to wade through water up to our waists, and then at the end of the walk to rid ourselves of the leeches. However, on that day, I was very much a conservationist.

The miners thus had come to Snedden as a last resort, because they had been told that even the union was not supporting the sand mining being retained. Yet this was not far from Newcastle, where the ALP is electorally entrenched.

What could we do about it?

Snedden chose to be publicly sympathetic. He realised very clearly that there is a political divide in this country, where one side saw representing its task of protecting labour, including here the role of the State, as paramount. Any support in any case would have been seen as opportunistic and fleeting, while alienating traditional supporters.

On the Liberal side, which Snedden led at the time, essentially the policies were around encouraging individual enterprise and the development of wealth, independent of the State, yet not entirely disregarding that the State had a crucial role. It provided certain services, which had been shown or were deemed better to be public enterprises. The problem with such a separation is that in a democracy, such attempts at differentiation are riddled with inconsistencies, paradox not to mention conundra.

Disaffected union members thus do not easily fit with the so-called Liberal side of politics when a basic two-party adversarial system forms the basis of this country’s democracy. The adversarial system has been distorted by the alliance of the protectors of free enterprises with the agrarian socialists who, in their purist ideological form, have been known to ally themselves with the ALP briefly.

There are other elements. The sectarian division in the ALP, which has resulted in once defenders of worker rights, albeit with more than a tincture of Roman Catholicism, separating themselves into the DLP. They crossed the political divide, were regarded as renegades by the ALP and eventually were destroyed as a Party. Elements remain as a core reactionary Falangist rump now embedded in the conservative side of politics far away from their traditional roots. Their ideological basis aligns more easily into the “new liberalism” which has evolved.

The other political party, which probably has progressed beyond the charismatic individual, is the Greens party, but there is no discounting the effect of Bob Brown on promotion of environment protection in Tasmania.

However, a proto-anarchic party, which paradoxically has blind beliefs as a substitute for reasoned policy, is doomed to irrelevance. As was shown in Western Australia hugging trees wearing a twinset and pearls does not win a constituency.

In the end, political parties which do not progress beyond the individual who sets them up or the individual who works the Senate system, primarily but not exclusively a Tasmanian phenomenon, exists so long as they exist. Who still remembers Brian Harradine and the antics he inflicted on this country to secure largesse for Tasmania? So in your lifetime, you were influential, but that Life of Brian, your legacy?

I believe very much in the definition of conservatism that to change your view can be done by persuasive evidence-based reasoning. However, such logic seems to be in short supply these days.

The problem with politics in Australia as I have written elsewhere, is that vested interests typified by the urgers, rent seekers and mercantilists on both sides of the political spectrum have emerged to distort and compromise the political process. They have one basic belief, irrespective of what side of politics they profess, and that is: “Government is an ATM. All I need to have is a password; that is a politician in my wallet”.

Vested interests squeeze out those who have a belief that the political party of choice will take account of your views, if you are a member.

It was salutary watching the 2010 documentary of the GFC debacle and how Wall Street and an array of “respected” academia were involved in almost destroying the world’s financial structures. What happened to them? Many of the perpetrators ended up not only with handsome dividends but also as faces among Obama’s trusted advisers.

Was anybody prosecuted as a result of the Wall Street shenanigans? Nope. No wonder Obama paved the way among the deprived for the ascension of a “saviour” who has avowed to clean the swamp with a broom, he himself infected by fake news and conspiratorial theories.

The Haynes Banking enquiry in this country showed the extent of our diseased society, but already the Government are unravelling the structural cures so recently put in place. Symptomatic?

Don Chipp had the right idea when he used the slogan “Keep the Bastards Honest” as his party’s brand. Unfortunately, Chipp did not have the intellectual capacity to articulate policy arising from what was a strong call for change and, most importantly, integrity.

However, 40 plus years on, with ongoing corruption so evident across the political spectrum, the demand for a “National Integrity Commission” is the perfect way in which what seemingly is a simple issue could become the centrepiece and rallying call for a national party. The issue should be attractive to most of the independent members in the House of Representatives. It seems a single issue, but it is not.

A simple single issue upon which to campaign has the potential to focus the electorate – an Integrity Commission – so much to say about how to promote such a body; so many reminders of integrity lacking in the current crop. Contemplate a party with a pristine white banner with a blue “I” one way-intersecting at right angles with a blue “I”. Maybe throw in a few stars as well.

Eureka may at last have a long term meaning.

The problem with any centrist party is that it has to have a structure, funding, and a strategy attuned to that. In an earlier blog, I suggested a Haircut Party aimed at reducing the entitlements, perks, and the overstaffing which politicians are afforded – something which would test those already within the “parliamentary tent”.

Being a member of Parliament as I identified in articles I wrote years ago when the entitlements and perks were far from what they are today had a number of challenges and bogeys. Staffers then had legitimate policy roles, rather than just harassing bureaucrats and playing puerile undergraduate one-upmanship scherzi. The individual targets such as the choleric Craig Kelly are many, but need to be franked in terms of lack of integrity.

I mention this just to assure those who do glance at this blog, that the two notions are not incompatible – a good haircut gives one a good view of integrity.

However, I am also mindful that after Cromwell died, five years after he uttered the above exhortation, the Rump resumed and needless to say, they exhumed Cromwell’s body and hanged him.

Says something for cremation – but also about embedding policy so that it has no single author.

The Spectre of Parkinsonism

The discussion about post-infective sequelae to viral infections should not surprise anybody. However, those people who carelessly disregard history should at least take notice that the possibility exists.

I had an uncle. He was a very active, successful businessman who built his father’s agency into a profitable business. He was closely involved in attracting Roger de Stoop and his Belgian enterprise in high-end fabric weaving to set up a factory in Melbourne.

However, during the 1930s as a young man my uncle contracted encephalitis lethargica, the aetiology of which has never been worked out beyond an influenza-type pathogenesis being suspected. It was also known as “sleeping sickness” because of the severe alterations in sleep patterns. Within the family, I was told that my mother helped nurse him.

In any event he seemingly recovered and was fit enough to serve in World War 2. However, in the late 1960s, he began to show neuro-psychiatric symptoms, which were initially diagnosed as “anxiety attacks” for which he was prescribed chlorpromazine. That just made him worse, and soon after he was diagnosed as having Parkinsonism, which rapidly progressed – the trembling hands, the mask face, the rigidity. It was the time that levodopa had just been introduced and to that was added the then experimental dopa decarboxylase inhibitors to try and dampen down his movement fluctuations. In hindsight, once his prior medical history was disclosed, the association with his prior disease was made.

The disease progressed and he eventually died, not the death that such a previously active man would have wanted. Nevertheless, even though I was never close to him, I have two strong contrasting memories of him. One was the uncompromising man with a fierce expression in his late forties telling me off in no uncertain terms when I was barely twenty-one – and rightly so; and the man 12 years later in a wheelchair barely able to talk. We two were alone briefly then. I got up to leave, shook his trembling hand and said good-bye. It was the only time I have ever touched anybody on the cheek; his brother, my father, had died years earlier when I was not allowed to see him until he was dead, cotton wool already stuffed in his mouth. But that needs more explanation at another time.

However, the spectre of Parkinsonism is real, especially if theoretically there was a long life ahead of you before the Virus came. I wonder whether it will be associated with a loss of smell, one of the symptoms of the Virus infection, because that may suggest an entry point into the brain along the olfactory cranial nerve, which is not only the shortest cranial nerve but also originates in the brain itself (rather than the brain stem, unlike all the other cranial nerves, except the optic nerve).

We shall see.

There is always a solution

It was a Saturday morning. The phone rang. It was my son. I was working in Broken Hill at the time and coming to visit me, he was in Mildura. He had been booked and had a ticket to travel on the Eastern Airlines Cessna 402 flight. However, he arrived in Mildura at the same time as the camera crew, with its baggage, which was about to film a Coca-Cola commercial outside Broken Hill.

The tiny settlement of Silverton outside Broken Hill had served as the image of the Australian Outback in multiple films, and the road out to the Mundi Mundi plains was the backdrop for the early Mad Max movies. The Mundi Mundi Plains are flat land stretching to the South Australian border, and sitting on a rock overlooking the plains watching the sunset makes one realise how lucky you are to be an Australian as long as it was not a set for Mad Max.

Mundi Mundi Plains

Coca-Cola was rumoured to have a set somewhere on the plains where they shot commercials, and who was this young man with a ticket to stand in the way of a commercial eulogising dark fluid which looks like haemolysed blood but a tried beloved method of stacking on calories for many generations of the world’s youth.

Anyway, son was bumped, and when he rang he presented me with the problem. There was one fight on Saturday; none on Sunday. He enquired whether there was anybody flying to Mildura that day who could pick him up for free. There wasn’t. We quickly dismissed the idea of him hiring a car to drive the 300 kilometres between the two cities. The cost would have been prohibitive for someone of his then age hiring a car under “remote” conditions. Hitchhiking: forget it.

However, there was one outfit from whom I could charter a plane and pilot. They said they could accommodate me – at a price. The pilot had to be roused and when he arrived unshaven, I ignored the fact that he drank a whole bottle of milk immediately.

All systems go.

I phoned the Mildura airport and let them know to tell my son that I was coming down to get him. I went with the pilot, who still stank of alcohol. Despite all the signs, it was uneventful; an hour down and an hour back. I cannot remember the type of small plane, but it was adequate to fit at least four. Flying to Mildura and back on a clear morning as this was before the thermals made their presence felt was diverting. It was a time when the waterholes were filled after substantial rain. When that occurs, it took about a year or more for them to dry out, if there was no more rain – and the farmers used to sow them – it was a harvest of pocket money. Generally, two harvests could be obtained. A tremendous sight.

Yes, I remember clearly this morning and these vivid spots of green, distinct from the unending blue grey of the saltbush, blending as it does into the ochre of the desert.

I always remembered this morning as one in which a potential disaster was so quickly solved – at a price. My son was given a taste of why Broken Hill is what it is – a place that everyone should see before they die. It is the essential Australian whitefella legendary Outback.

My son met Pro Hart while he was there, said he was broke, and did Pro Hart have anything he might have for free. Pro Hart probably thought he was an urger, but generously remembered he was probably the same when he was my son’s then age. The son still has the purse with the Hart dragonfly painted on one corner.

In a way, it was a variation on that wonderful “The Gods Must be Crazy”. Here the Coke bottle stayed in the plane, and bumped my son onto the tarmac. Never thought that I was a bushman or my son was a surrogate for the Coke bottle.

Andrews – a Career going North?

The future is not about his response to COVID-19. Andrews made the wrong decision, just as he narrowly avoided a similar debacle had he allowed the Grand Prix to go ahead in March. If he had done that, and it must have been a close call, Melbourne’s “first wave” may have been as bad as the second. So I hope he remembers who gave him that advice to pull out. Otherwise he would have been cactus.

The Health Minister, Jenny Mikakos, recently resigned and conveniently, being a member of the Upper House, her resignation will require no by-election to fill her vacancy and thus few ripples. Depending on the media, she will become a footnote and then forgotten like so many. However, the parliamentary election of her successor may generate a platform for some of the more infantile in the Opposition.

Ultimately no matter how softened, Andrews will be tainted with the decision to hire the private contractors. Whether it was out of contempt for a Department over which he once ruled or not, Victoria was ill-prepared for a major public health emergency. The problem with Victoria, and Melbourne in particular, is that the politicians are continually being told how wonderful medicine and medical research is in Victoria and thus there is a belief that Victoria can weather all ills because of the Parkville precinct. It is more the Parkville rather than the Stockholm Syndrome. Generation after generation of politicians and business leaders have been lulled into believing this.

In this sea of self-congratulation, public health was a casualty. Now public health is very central, and what is happening clearly has been painful for those within Melbourne in particular; but are we witnessing what has to be done when the Virus calls. It is obviously shambolic elsewhere in the world where the Virus is rampaging. Does it need politicians with the resolve of Andrews and his tactical skill to control the outbreak?

Andrews tried the carrot but needed the stick to bludgeon the Virus out of the community. Victoria has surely seen a winter of discontent, but Australia faces a summer far better placed than elsewhere in the World, where the Virus has already conquered and colonised. Here the Virus is being forced into the underground – a terrorist force nevertheless, which will break out. Think ISIS; think Virus – a smaller form, but nevertheless terrorist.

Thus, the challenge for Andrews is to know when his anti-terrorist support is strong and reliable, able enough to be maintained, so that he can “declare a peace” and free his people, who are now knowing the anguish of wartime.

Are the lessons learnt in Victoria generalisable? What time is required to suppress the Virus once it is rampant? What is important is that Andrews has overseen a bungle, responded decisively, and did not cave in despite some attempts, particularly by some elements of the media intent on giving him a permanent pariah status. The legacy of these decisions is yet to be known in full; the Virus has been suppressed – but at what cost?

Reponsibility has been handpassed from Department to Department. But we all know. Of course, who caused the stuff up was the Channel-9 cameraman.

Penitents in Holy Week

In the end, scherzi aside, let’s face it, if you stand out there as the Premier has done, enduring all the slings and arrows day after day, recognise that this is an act of penance. Soon, the penitent can remove the purple drapes, forgiveness has been given? Who knows whether the electorate will give absolution. In the meantime, Victorians, you should move on. There will be no Pallas Revolution.

Mouse Whisper

“Thanks be to God,” Father Ted was breasting the bar of the Balaclava pub in Whroo when he heard.

He remembers when his mate from school, George Pell, could not travel back to Australia because of health problems.

In 2016, supported by a two page medical Report, “Cardinal Pell’s office in Rome issued a statement at the time saying his heart condition had worsened, making it unsafe for him to travel.”

In 2020, glory be, miracle of miracles, a medical report unnecessary because of such a miracle, Cardinal Pell did not issue a statement that his heart condition four years later has improved to such an extent, he was able to scuttle back to Rome on Qatar Airways.

Or perhaps the clouds of civil cases have begun to gather.