Modest Expectations Doze

Welcome to the 12th edition of The Best Mouse Tap. For the first time we have two guest bloggers who introduce some interesting diversity:  traditional bush cooking and why Australia’s Pacific aid should be built on ferries, together with your weekly dose of politics.  Guest Editor: The Pangolin

How to Cook a Kangaroo – Part 1

Recollections of Charlie

I saw first hand how desert aborigines cook kangaroo at a place called Tjiterong, 500 km due west of Alice Springs, where the east west running MacDonnell Ranges begin to peter out to a series of red quartzite hills rising to about 50 metres above the surrounding plains with the water runoff making for the relatively lush arid mulga and native grass land that can support the red kangaroo of the inland.

To the north the Tanami and Great Sandy Deserts are the lands of the Warlpiri, Pintubi and Mardu respectively while the south has the Great Victoria and Gibson Deserts of the Pitjantjatjara, Ngatajara and too many others to mention here. Precisely it is the meridian 129’ which forms the border of WA and NT; funny how Australian borders follow post-enlightenment Cartesian geometry devoid of the human history goings-on that usually define boundaries.

In my travels I was gratified to learn that the desert clans occupying about a third of the Australian continent are not as diverse as the 50-odd different ‘tribes’ illustrated on the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) map. They all have the same kinship names like Tjpangarti, Nampitjinpa from the Great Australian Bight to the Kimberley with the same core words like marlu (kangaroo) warru (fire) and watti (man).

This is background. What I write about Pintubi is based on my experience and may be contrary to the ethnographic record.

We were at Tjiterong to get a truck tray load of gravel to make concrete splash pads beneath the taps on the water pipeline being made for the new community of Kintore. With me was Henry Tjapaltjarri – about my then age 30, Tony Tjupurrula about 15, a son of the fearsome Freddy West Tjakamarra, jovial Pinta Pinta (meaning butterfly) with his child Matthew. Adam “King Kong” Gibson who had the manly stature of his father the noble Yala Yala Gibson Tjungarrayi, and the “poor bugger” Frankie Tjungarrayi who everyone called Tjina Bompa owing to his awkward spastic walk and mental disorder.

Pinta Pinta was the elder, aged perhaps 37, spoke little English and had met “white fellas” in about 1965 when the western Pintubi were induced by declining numbers and an easier life to move to missions and government run settlements. The hole through his septum marked him as an enthusiast for traditional lore. Circumcision and some chest scars and maybe a front tooth knocked out (as Henry had) were the initiation pain for manhood but only the keen went for having a hot kangaroo bone pierce their septum. I had seen in general company how Pinta Pinta had the kind of face that smiled easily, was not taken too seriously in general company, and so lived up to his name “butterfly”, but with the men at ceremony he was accorded great respect saying a lot with great enthusiasm. He also was ngangkarri (medicine spirit).

Well before the creek, Pinta Pinta and Henry simultaneously sighted a pair of red roos that bounded off. The hunt was on. We had to stop to tie up my dog Danger who would have bolted after them and to get my 22 magnum rifle from behind the Land Cruiser seat and then ride on the back tray with the rest of the crew. Finding the roo track Henry drove at a good pace till he sighted the roos again and accelerated after them. Holding onto the ute tray bar with my hook arm and the loaded rifle in my good hand was fraught to say the least. The ute swerved between mulga trees and crunching over dead fallen ones with exposed spiked mace-like roots that looked like they would impale a tyre at any moment. Staying on board with loaded gun was difficult enough, let alone taking a shot and it seemed that Henry was intent on running the roo down with the bull bar anyway. But I started to worry less about a crash as it became apparent Henry was an exceptional off road driver, way better than me and the HJ 45 diesel Land Cruiser was the hardiest 4 x 4 ever made. There was no chance of shooting anything in the rumble of the chase and I lowered myself to squat on the “ute” tray to wait hopefully for the end to the mad chase.

Frankie, Tony and Allan were having the time of their lives shouting out suggestions on tactics and direction. There were perhaps six roos in the mob and we would lose sight of a couple only to find another lot again in the thin mulga. After about 15 minutes it became calm as Henry slowed to driving steady and slow, taking wide sweeps of the terrain then pulled up, diesel engine idling “clunk clunk.” There was something there judging by the talking, quiet but eager up front, and “hush hush” tone of the fellas on the back of the ute with me. (to be continued)

Charlie McMahon is the bush polymath, leading exponent of didgeridoo, inventor of the Didgeribone and co-founder of internationally acclaimed band Gondwanaland. 

Safer ferries for the Pacific islands:  A politically valuable aid export opportunity in Oceania

Neil Baird

The very obvious fact that Prime Minister Scott Morrison chose the Solomon Islands as his first destination following his re-election last month confirmed the importance of our Pacific island neighbours in the minds of many aware Australians.

Numerous recent ferry tragedies in Indonesia, the DR Congo and Hungary (reported dramatically in The Australian) and, earlier last year, another in Kiribati, the second in nine years in that tiny country, reminded me of the obvious opportunity that exists for Australia to contribute to the elimination of such distressing events.

In mid-2018, I wrote to the then Minister for International Development and the Pacific, Senator Concetta Fierravanti-Wells, outlining the following proposal. I received no reply from her but I am not discouraged. I continue to believe that it is an excellent and very practical idea.

Our overseas aid organisation, AUSAID, is involved with numerous assistance programmes in many of the “Happy isles of Oceania”, as Paul Theroux ironically called them. I’m sure that many of them are very worthy. However, from my observation of some of them, I note that most of the money involved, apart from the usual large slice that goes to Canberra, is spent beyond both the islands themselves and Australia. I suspect that Toyota, for example, is a major beneficiary of our aid.

While, rather than being “happy”, many of the isles of Oceania and to our “near north” appear more likely to be as impoverished and dysfunctional as Kiribati unfortunately is. And, worse, most of the aid programs aimed at them appear to be “finger in the dyke” exercises of little lasting economic benefit. I am sure we could do much better.

All of Oceania is extremely archipelagic in terms of geography. In other words, the only practical way to get around is by boat, more specifically by ferry. Here lies a major problem. Many of the ferries operated in such countries are unsafe. Indeed, over the past fifteen years there have been at least five significant fatal ferry accidents in the Oceania region and many, many more in south and east Asia that we know about. In Oceania alone, those accidents have resulted in more than 500 fatalities, a big slice of the small local populations. In Asia, of course, the toll is dramatically higher.

There are three main causes of those safety deficiencies. They are all, obviously, driven by poverty. The islanders cannot afford to buy and maintain safe vessels or to have them competently crewed.

We will probably never really know precisely why the most recent (2018) Kiribati tragedy occurred but, given the similarity of the vessels concerned and their common ownership, with that in the last such event in 2009, it is a fair bet that an unsafe, badly maintained, overloaded, incompetently crewed vessel proceeded to sea in unsuitable conditions. Most such accidents in developing countries occur for one or more of those human error based reasons. The numerous Indonesian disasters of the past twelve months will undoubtedly prove to have had similar causes.

From my travels and observation in the area, as well as the recorded facts, I have learnt that such problems are endemic. I also know that far superior solutions to the latest Fijian one are readily available in Australia. To explain: a Fijian company recently purchased a more than 65 year old monohull Ro-Pax ferry from BC Ferries of Canada. Can you imagine buying a 65 year old aircraft? That ferry was designed for the sheltered waters of British Columbia, not the trade wind exposed seas of Fiji. It also happened to be un-saleable in North America because it is riddled with asbestos. However, it was cheap. So too were the Princess Ashika and Rabaul Queen that sank in 2009 and 2012 in Tonga and PNG respectively, with at least 400 fatalities between them. It is rumoured that the same Fijian company has tried to purchase a further two similar vessels from Canada!

Therein lies part of the problem; the others are maintenance and crew training. All are areas where Australia has considerable expertise and resources. We are renowned for designing, building and maintaining safe, economical ferries, mostly catamarans. We also have a number of excellent maritime training organisations including the Australian Maritime Academy and the Australian Maritime College.

So, we do have excellent potential solutions. But, as obviously the islanders cannot afford to purchase Australian vessels and training themselves, that gap must be bridged by aid. Such aid would benefit both the islanders and the Australian maritime industry, rather than Toyota. I raised this suggestion early last year at a regional maritime safety conference in Port Moresby. It was warmly welcomed by the maritime safety authority directors of all the Pacific island nations who participated.

We have numerous naval architects and ship builders for whom the design and construction of simple, strong, safe, low-maintenance and comparatively cheap ferries would be straight-forward. Our maritime schools are already training islanders, just not enough of them. We already supply many of the island nations with Pacific Patrol Boats and their trained crews. Why not do something similar with ferries? An aid programme based on the Pacific Patrol Boat template would be simple to implement. Ferries would be much cheaper than patrol boats and, arguably, more effective. For the same money as we spend on patrol boats we could supply many more ferries.

Australian-built 35m catamaran – an ideal ferry for Pacific island operations

I realise that the patrol boats have their uses. They have improved the island nations’ incomes by ensuring the payment of fishing access fees and they have rescued lost fishermen and helped in disaster relief operations. However, new safe ferries could help prevent significant loss of life and also assist in rescues, poacher pursuit and disaster relief. A Pacific Ferry Programme could be developed using the patrol boat programme as a model although, hopefully, with less chaotic and expensive Canberra input.

Rather than funding cultural centres and basket weaving classes that have little or no economic or social benefit, how about we renew our aid programme focus to something more practical and valuable? Something, co-incidentally, that has more direct benefit to Australia and not Japan, China or Korea?

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

Chisholm – My last rumination on the Lessons from 2019 Election

I grew up the electorate of Chisholm as it is now. It was outer suburban, white and Anglo-Celtic. When I first voted it was Bruce, then a safe Coalition seat. Over the years as the population has grown, electoral boundaries have shifted and Bruce a long way away in suburban terms, from where I first voted, to Dandenong.

The biggest population centre in Chisholm, Box Hill, has grown to be a major transport hub and the whole immediate area around the train station resembles a suburban Chinatown.

In the last election in 2016, Julia Banks won the seat against the swing to the Labor party unexpectedly. Her Greek heritage never seemed to be raised as her reason for her election although there is a sizeable population of Greek heritage in the community.

This time the two major parties pitted two women of Chinese extraction against one another. The Liberal Party held the seat although there have been rumblings about a poster in Mandarin, which it is alleged gave the impression that it came from the Australian Electoral Commission, ostensibly favouring the Coalition candidate. There is no accompanying English translation.

What was not emphasised was that the redistribution of the electorate favoured the Coalition to the same degree almost as much as the final margin. In other words, although a marginal seat, it was notionally distributed to more a Liberal seat. There was a swing to Labor of 2.2 per cent – close but no cigar!

The psephologists will be at work trying to work the Chinese voting pattern. However, the controversial poster started me wondering about the local Chinese language newspapers. I cannot remember any of the mainstream press regularly summarising the stories which appear in Mandarin and any commentary and opinion which accompanies any reports.

There is increasing academic activity in determining how the Chinese population receive their media. A survey of 500 people of Chinese extraction was undertaken by an UTS academic, who stated the following summary of his findings:

Our findings suggest that to reach the majority of Australia’s Mandarin-speaking media consumers, stories need to be:

  • picked up by local Chinese-language digital media outlets
  • delivered via a WeChat public subscription account (which individuals access using a mobile phone app)
  • directly relevant to the interests of Chinese migrant communities.

I can read the English version of the Chinese government opinion if I want to, but I have no idea whether the Mandarin version says the same thing.

Not that I am paranoid but the election poster written in Mandarin without any English version I find disturbing if it purports to represent AEC policy. There was no translation readily available on election day, and in a way I am surprised the AEC did not order its removal, even though the AEC is widely reported as having said the posters had been properly authorised, no laws had been breached and anyway the AEC didn’t “own the colour purple”.

Everybody bangs on about a multicultural society, but for better or for worse English is our national language, and therefore it becomes a matter of judgement how far we press for English sub-titles in public matters.

In a free and open society English is most spoken and read, and society should conform to this language as the major form of public communication. This is not to denigrate maintaining cultural diversity in private, the need for interpreters, and public displays of multi-cultural harmony.

In summary, matters of public importance should be clearly displayed in English. Thus, the Chisholm poster should be subject to a formal review so we can get our rules clear. In so doing clear advice can be provided to countries who may be tempted to bypass the English language in order to seek an advantage, even if it is only a poster in the colours of the AEC on election day.

Mouse Whisper

My learned friend has queried polling and the voting patterns among voters of Chinese extraction. Before the Bennelong by-election in 2017, Bennelong was said to be the most “Chinese” Federal electorate, and the Fairfax media reported:

An online poll of the Chinese community seen on Monday by Fairfax Media indicates Labor’s candidate, former NSW premier Kristina Keneally, holds a large lead over the Liberals’ John Alexander, drawing 66 per cent of the votes.

The ongoing poll is being circulated on the popular Chinese social media app WeChat by Sing Tao Daily, the largest Chinese newspaper in Sydney, and ends on Thursday.”

In fact, John Alexander retained the seat 55 to 45 per cent at the by-election. The Chinese must be different, some say in defence of the poll. Which leg do you want to pull?

Nevertheless, this disparity may say something, but then I am only a mouse with a murine brain. Does that not say something about polls? You know the ones that repeatedly put one radio performer at the top of the radio ratings in Sydney – and how many polls did the Federal Coalition lose in a row? As I said, all too much for my murine brain to handle.

Modest expectations Jiminy

In the Weekend NYT, there was a thought-provoking article saying we now have a great way in Instagram of recording aphorisms – the one-liners, deep philosophical verbal gestures. Jean Crispin writes:

“This should be the golden age of the aphorism. Constrained as we all are by time, attention and social media platform character limits, when we pull out our smartphones and stare into their illuminated fields, we can take in only so much. Shouldn’t those words be perfectly chosen to vibrate with hidden meanings?”

An aphorism has a way of bending you to its hidden truth, changing your way of thinking not with a 20-page document of well-reasoned arguments, but with just a sentence or two.”

I have two responses – one is that an Instagram is a vehicle for one line vanity press – “Look at me, aren’t I clever?” Mostly, the answer is no! In fact, given the weight of encouragement her opinion may give, I would introduce a Crispin Licence to Practise in her golden age.

The other is a question: “Have you ever read an anthology of aphorisms.” It is eye-glazingly boring unless you want to filch one and then pass it off as your own cleverness.

However Chris Brook, later in this blog, makes a very valid point, if obliquely. The name “blog” implies stodge as if we are working our way up a muddy hill. However, as Brook points out, the blog is a very good place to set up a conversation as long it remains coherent.

A blog is a modern cartouche. Not only does it name the author who is trying to explicate an eternal truth but also in itself it is self-contained. As I am writing, I glance up and see the front wall of our house; it is a variegated set of bricks that have been put together to cohere. Not exactly the wall of a Pharoah’s tomb, but the wall of brick cartouches is a sufficient metaphor for policy by cartouche aka blog. Thus, the blog can be used to build a policy wall, which Chris Brook is doing incrementally with his health policy contributions.

Napoleon Bonaparte, when he saw the ancient Egyptian way of hieroglyphic messaging, thought it looked like a gun cartridge, hence the name “cartouche”. I am sure he would have had a less viscous name for “blog”, perhaps “L’araignée boisée” abbreviated to “abois”.

A Memo to Me Mate the Minister for Minerals

Change is something that can take a long time. Therefore it is useful to live long enough to see change happen and then see the society change, especially when you yourself started on the wrong side of history.

By this I mean I started smoking when I found a half empty packet of brown Capstan in the train on the way home one night when I was 17 years old and from then on I smoked until I was 40, when I gave up. I have never had a cigarette since. But back then tobacco usage was pervasive. I owned several pipes so that tobacco could give me gravitas. They didn’t.

One of my memories is being in the emergency department during my internship. We used to light one cigarette from the butt of the last one. Many of the senior doctors smoked and we were corralled into the room at the end of the ward so that he, the senior doctor, could have a smoke (never “she” then) while he taught. The Medical Journal of Australia had until recently then been accepting advertisements from cigarette companies. My father, who was a doctor smoked cigarettes and more often Cuban cigars. He died in 1970 – he had a heart attack. It was Tobacco that helped get him.

It was Richard Doll who, with his colleagues in Oxford, identified the link between lung cancer and cigarettes from the late 1940s. He authored an article on doctors’ smoking habits in 1954. This whole public health investigation was not on the political radar, and even when it was there was a reluctance to interfere given how much cigarette money was sponsoring so many activities, including political parties.

Like many of my contemporaries in the health industry, I had one particularly uncomfortable moment on the way to weaning myself from cigarettes. I happened to be in the office of one of Jimmy Carter’s advisers. I asked whether he would mind me smoking, pulling out a packet of Gaulois. He looked at the packet and suggested that they were worst cigarette to smoke from a lung cancer point of view. Needless to say the rest of the conversation could have been better.

However, it was three years before I abruptly stopped. By that time I was working for the AMA, but there was no overt pressure for me to stop. I just decided one day it was a dirty habit. I just smelt. Cigarette ash like coal dust was a pollutant. So I went cold turkey. I surprised myself and never smoked again. And one of these days, we as nation will have to go cold turkey on coal, before it is too late.

The only contribution I have made to policy in this area of tobacco happened one day in the early 1980s during my time at the AMA. I was rung up by a friend who was then on his way up the bureaucratic ladder, who asked what I thought about indexing the excise on tobacco products. I said great idea – and QED, it came to pass.

However, far more importantly, community behaviour has changed in Australia. The smoker is very much a pariah in public places – the array of butts on the windy corners of the city reinforce the image of the uncaring polluter.

One wonders how long it will be for those who hold up a lump of coal in Parliament proudly, to be like the young doctor in the emergency department lighting a cigarette amid an atmosphere of tobacco smoke, and change. Hopefully it will not take 17 years.

One cigarette executive once said of me that I was a hypocrite in my attitude to smoking. No, I said, as our coal-fired politicians and their minions hopefully may eventually recognise, they will eventually become as I did over the matter of cigarettes – a penitent.

Not to everyone’s Taste

When I went to the Baltic States a little time ago I visited many churches. I climbed the Hill of Crosses in Northern Lithuania. My visual cortex is an attic stacked with images of Christ the Child and Christ the Man. These are not my image of Christ nor indeed of my God the Father who dominates those below as if some Jovian presence as though Heaven is at the top of a religious escalator. As for the Holy Spirit as some wraith dodging in and out of my cerebral inglenooks … really?

Hill of Crosses

I therefore cannot conjure a visual image of the Trinity. I do not have the capacity to do so. They are not Three clustered on a Throne. I am thus left with my other known senses to provide me with some reference point by which I can relate to the Trinity.

I cannot touch Them, although in some worlds people seem to believe in the supernatural. Whether that is some kinaesthetic experience where God in various forms intrudes is again beyond my ability to fathom.

I cannot hear God. It is not that I am deaf, but I have not had the experience of having auditory communication, although I may have missed it – by not having paid enough attention, not being able to break the code or simply not knowing the language.

I thought that since frankincense and myrrh were so important in the Nativity that perhaps there would be a particular fragrance where I may be able to smell God. To me substances that emit a smell are important to my being. In particular I love herbs in all their differentiation. The Bible is full of references to herbs, and for a moment I toyed with the ability to distil these olfactory sensations as a means of conceiving God. But then the idea was too difficult and my brain inadequate to process – at least at this point in time.

Then there is taste, and in the early hours of one Thursday morning, I realised that when I have taken the Bread and the Wine at Communion it is somehow different. I cannot express that thought any further, but taste is a very complex physiological phenomenon. Taste is itself a trinity of cranial nerves – the facial, the glossopharyngeal and the vagus.   Surely that is a coincidence!

Perhaps, just maybe, that is how God is in my head. But I am still uneasy and unsure to presume even that. But it is the only way I can sense my God.

Chris Brook on Health

Whenever the future of the Australian health system in Australia is discussed, the discussants tend to focus on their own area of special interest and to adopt the “gap filler” approach. It is the basis of incrementalism.

It seems pragmatic and sensible to target perceived areas of deficiency. Examples of this currently are:

  • universal dental care (a costly initiative if ever adopted)
  • mental health care including youth suicide ( very deserving of consideration)
  • better public information to facilitate informed decision making
  • integrated care initiatives.
  • In fact the list is endless. It is a question of priority.

Filling gaps seems to assume that all is otherwise rosy in the health care system, when of course it is not. I listed above some of the schemes. Underlying the edifices we wish to build are the fault lines.

  • Think how far dental health schemes are from universality
  • Think lack of coordination between GP type primary care and specialists
  • Think of the gulf between hospital care and any form of community based care whether specialist, general practitioner or other
  • Think cost shifting between levels of government between care settings and funders including private insurance funds, a set of pernicious behaviours raised to an art form in some jurisdictions
  • Think out of pocket costs and deliberate privatisation of services
  • Think of the difficulty for the increasing number of people with chronic and often multiple morbidities in navigating the fragmented health system.

Above all, think “systems”! Then ask why don’t we actually have one! For historic reasons we have a set of arrangements based largely on fee for service, whether Medicare, Hospital casemix funding, or Pharmaceutical Benefits scheme.

Multiple costly government attempts to engage general practitioners, with the latest being primary health care networks (PCHN), but also with practice incentives, IT incentives and without anything similar for specialists. They just have not been sensibly considered.

There are many questions about the Australian health system. For example, why is Australia’s rate of hospital admissions some two and a half times greater than virtually all other OECD countries? The answer lies solely in what Australia counts as an admission where it includes day treatments and day procedures as admissions when no actual overnight stay is involved. Once this is taken into account the Australian apparent admission rate plummets to the normal international level. Australia does this for accounting and payment purposes and it may be said that it works reasonably; but could it be better if done differently?

Many countries are far more advanced in consideration and implementation of capitation-based funding for large parts of health care, adjusted for risk using some really very good predictive tools, such as DxCG predictive for risk.

The appeal of capitation since the 1930s has grown with the birth of Health Maintenance Organisations like Kaiser Permanente. Offering an annual payment for all care should allow flexibility in the “what and where” of care including, most importantly, preventive services. It should allow tailored care for individuals and greatly facilitate navigation.

The theory may not always translate because the bogey of managed care is that it is rationing in disguise – and rationing has caused many problems notably in the USA, in particular knowing where to draw the line.

Nevertheless, capitation has its advantages, especially for the funder.

Fee for service at the extreme is a free-for-all encouraging providers to offer as many services as possible to as many people as possible, whereas capitation encourages providers to offer as few services as possible to the least number of people.

So measurement of adequacy of patient benefit must be part of any approach, being preferably outcome based, incorporating the triad of: clinical assessment, whether periodic or after a specific care; patient reported health outcome measurement, including some measure of satisfaction; and periodic functional assessment. Here elective surgery is the easiest one to reference – post-joint surgery or post spinal surgery; one functionality, the other more relief of pain.

Barriers are pervasive. The structure of the Australian Constitution originally only accorded one Federal health power – that of quarantine – and has made the Australian health system a patchwork, which is increasingly fraying around the stitches.

One blog is too short a space to go much further, so take this as just a start. Serious policy is always work-in-progress. However serial blogging over time will help, as now is a very appropriate time to take this whole policy area much further.

The rise of the zinger

I remember when the late Senator John Button, in a mischievous moment in the Senate, once asked the Minister of Science a question without notice: how many centimetres there was in an inch? The Minister did not know. Button achieved his point; he made the Minister look like an idiot. Although amusing at the time, it has not improved the quality of the politicians who have been given the science portfolio – that is when the portfolio hasn’t been abolished.

Alan Jones uses the same ploy but slightly differently. Ask a relevant question when confronting someone ideologically at odds, but unlike Jones who does his homework, the other person has not done so.

So when Jones asks one of these adversaries what is the current level of CO2 in the atmosphere, and that person doesn’t know, Jones goes on his victory tirade. It doesn’t matter if that person knows the answer, reality is not based on some human dot not knowing the answer.

Oh please … the zinger. Smart, but it doesn’t help when we are seriously discussing the future of Planet Earth.

The reality is that the level of CO2 in the atmosphere is straight lining upwards like the trajectory of a bullet into the sky. We have passed the 400 ppm mark.

If fossil-fuel burning continues at a business-as-usual rate, such that humanity exhausts the reserves over the next few centuries, CO2 will continue to rise to levels of order of 1500 ppm. Then forget about the human race. Think Venus with billowing clouds of CO2 disguising the uninhabitable planet surface below.

But Alan, you will not be around, nor shall I – but unlike you, I have descendants for whom I feel responsible.

Mouse Whisper

Three years too soon? Or don’t talk about the Polls? It was not only Newspoll. Some weeks before the election …

“Labor is comfortably ahead of the Coalition in the latest Guardian Essential Poll, and just over half of the voters in this fortnight’s sample, particularly voters under 34, worry Australia is not doing enough to address climate change.”

Modest Expectations – Whistling Dixie

I have just been looking at the election results again, and remembering very clearly the backslapping which occurred with the landslide that Bjelke-Petersen effected in the 1974 election in Queensland when the ALP was reduced to 11 seats. At the same time the Queensland Labor Party, the Santamaria-Vince Gair offshoot, was wiped out completely.

The only safe Labor seat left then was Port Curtis or, as it is now named, Gladstone. True to form, in the 2019 swing to the Coalition in the electorate of Flynn, which is a pendulum electorate at the best of times, Gladstone remained Labor as did much of Rockhampton.

Queensland has this history over the past 50 years of being electorally volatile.

However, what intrigued me recently was Blackwater, which is touted as the coal mining capital of Queensland; the coal is exported via rail to Gladstone. The two booths there voted strongly Labor, as did the electors of Bluff down the road where the coal trains interchange in 2019.

The story of Blackwater is instructive – named because of the colour of the water passing across the coal seam. It had a population of 77 in 1966. Then the open cut coalmines came and the population swelled to 10,000 in the 1970s to decline to a current figure of about 4,000. There were about 1,000 voters at the two booths. The majority voted Labor (57 per cent at one booth and 64 per cent at the other). It is also true that other coal towns across the Bowen Basin of Collinsville, Moranbah, Dysart and Tieri all voted for Labor.

Small figures but instructive as a pointer. Given how unreliable the polls are, you might as well attribute the swing in Flynn to the State Government with the duumvirate (or more correctly duamfeminate) of Palaszczuk and Trad, as to the substitution of Morrison for Turnbull. However, quite rightly there was the Longman by-election and subsequently the swing back on May 18, which would point more to the second as the major cause for that phenomenon Nevertheless, change is not always due to one factor.

Flynn has a great many people on the land doing it tough because of the drought, and as you cannot directly blame God, well the State Government may as well cop the blame through its surrogate, Shorten, despite him being the son-in-law of the Queensland Dame, surely a person of renown in her own State.

Blackwater is just one of 40 odd mining centres in the Bowen Basin, which is South of the Galilee Basin.

Admittedly one of difficulties in defining voting patterns in the Bowen Basin is the number of “fly-in-fly-out” (FIFO) mining employees, estimated at 18 per cent of the population. It would be interesting to know the home postcodes of these FIFO miners but the assumption that they are locals, who earn the money that sustains the local economy, needs to be tested if we wish to clearly define the miners’ voting patterns. 

Strathmore Furore 

I came to Australia as a 14-pound “Pom” on the S.S. Strathmore, a P&O liner. The 14 pounds is an estimate. I might have weighed a pound more or less at four months old, in 1946, when I arrived with my Mum. The ship berthed first at Fremantle.

Somehow the Sydney Daily Telegraph had got wind of stench from our ship. Was the Fremantle Doctor that stiff a breeze to reach Sydney?

The story the paper ran the day after the Strathmore arrived was headlined: alien passengers filthy, ship’s passengers allege. Unbeknown to me for sixty-odd years, around 200 refugees had boarded the ship in Port Said—distressing many of those who, like us, had embarked in Southampton.

A Mr Pugh (“ex-R.A.A.F”) said to the Telegraph: “They are mostly women over 50. “Some,” he added for good measure, “are aged 70”.

That sexism and ageism was just lustre dust to the real thrust of the tabloid’s story: These filthy Germans, Austrians, Czechs, Palestine Jews, Cypriots, Greeks and Maltese were covered in sores and so dirty that the real passengers dare not dip their toes into the same pool.

A Mr Spencer of Regent Motors in Melbourne described the refugees as verminous, pointing out that they refused to be deloused. He demanded, “Why don’t we select our migrants from the magnificent types offering in England, and in Norway, where there are 10,000 ready to come here?”

The Sydney Morning Herald also made news of passengers’ complaints. “They’d turned the ship into a floating ‘Tower of Babel’ (and) wore peasant-type shawls draped about their heads (or) jackets gaily bedecked with patterns worked in silver wire.”

The Herald too handed Messrs Spencer and Pugh a megaphone. Each said in turn:

“The immigrants spat on the decks, threw their fruit peelings everywhere, and hung their washing across the deck promenades. It staggers me that Australia should have to rely for its population on the type of people that this ship brought.”

Sydney’s broadsheet listed just some of the languages spoken in the seagoing Migdal Babel: Hebrew was the first mentioned … then Egyptian, German, Greek, Italian, Polish, Austrian, Hungarian, Yugoslavian (sic) and Czechoslovakian (sic).

The furore ran for several days in newspapers around Australia.

Then the following Friday, The Sydney Morning Herald published a letter from a man called David Hand. He was a passenger on the ship, an Australian, who was also an Anglican priest. His five-paragraph letter was written “purely in the interests of truth and justice”.

The fourth paragraph reads: “As a priest on board, I had occasion to learn a good deal about the moral or immoral behaviour of the passengers; and I know that the highest officers of the ship would support my contention that the morals of the British people were no better – perhaps worse – than those of the ‘aliens’.”

He added in the final paragraph, “Those who were privileged to get to know any of them usually found them friendly, keen to learn Australian ways and language, and full of admiration and gratitude of the British people.”

I must have had my foot tickled by one or two of them because I have always sensed what he means by “privilege”.

ME & my mouse are indebted to John Bevins for this recollection. John was responsible for some of the most potent and innovative social marketing and advertising campaigns from the 1980s to end of the century. 

Flynn Addendum – A Message for Albo

This is a tiny parable about the town, which perceived unfairness and bullying.

There was this Tamil couple with their two Australian-born daughters, who were taken from a Queensland town called Biloela in the electorate of Flynn (the majority of which voted 58 per cent for the Coalition). They have been in detention in Melbourne since 2018 under the Dutton aegis, to be deported back to a country where 48,000 Tamils have been killed.

Biloela liked this couple. In fact a petition was raised for them to stay – many people are signing it. The flag over Biloela is not blue. Fifty four per cent of the Biloela citizens voted Labor on May 18. Biloela North admittedly voted 51 per cent Coalition. However, Thangool, 12 kilometres down the road voted 71 per cent Coalition. “Small numbers. Means nothing.” Or perhaps just an example of small town fair play disliking the Big Government the Coalition says it despises and keeps banging on about.

The parable of this story is taken from the Book of Morrison paraphrased: “There is no fair go for those who are forced to go.” 

Coal and the Pro-Adani Canavan

Matthew lives in Yeppoon. He has a wife and four children. Yeppoon is a coastal community that is renowned for its beaches, tropical climate, and the islands out on the bay. So says Wikipedia. It is where people who can afford not to live in Rockhampton go. Rockhampton is on the Fitzroy River far from the coast. It is not the place in which to spend summer. Yeppoon is better.

Yeppoon does not have a coalmine. Matthew has a younger brother called John. John likes coalmines. In fact he has been reported as keen to acquire the Rolleston mines, which were surplus to need for Glencore. John and Matthew seem to regularly communicate about their love for coal.

In a cuddly meal at the “Brekky Creek” Hotel in 2017 with the AFR, Matthew’s position was described thus: “The senator has become an avid reader of mining history and uses it to justify his position to use taxpayer funding to back Adani’s controversial mine, saying a leg-up from taxpayers helped get all new mining regions off the ground, evoking the “if you build it they will come” attitude of the Bjelke-Petersen era.”

Now I live around the corner from where there was once a coal mine, next to the primary school. The two mineshafts, Birthday and Jubilee, were sunk in 1897, and named for the 60th year of the Victorian reign. In fact my late neighbour as a boy used to dart round the corner to get lumps of coal from the dump for the family fire. He would brandish them triumphantly as he scooted home. Lots of soot in the air but it was only where the working class lived.

Matthew would be proud of how the then NSW Government offered to assist the viability of the coal mine when eventually after 30 years it was shown to be uneconomic, but in his terms needing “a leg-up.”

Oh, it was so picturesque, Matthew. Undercapitalised, the mine was never mechanised; so there were pit ponies lowered every morning to work in the mine’s narrow shafts. There were 159 men on the day shift, and the atmosphere was dusty with the temperature reaching 38 degrees C. Miners had a short life.

It is impossible to reconcile why any Australian government would tolerate such a situation, but during this time it was mostly a Labor seat with the then H.V. Evatt being one of the members for the Balmain seat when the miners were working under such appalling conditions. So much for his occupational health credentials!

But I digress. Even as late as the mid-eighties there were discussions about using the mine for gas supplies, and I remember that the opening to the mineshaft was still visible at that time.

Incidentally the remediation process for the mine took decades, including the death of three workers in an explosion of methane gas. To make the mine safe after that tragedy needed four million gallons of water – not sea water, fresh water – to get rid of the coal gas. Note water usage, Matthew.

As a student of mining history, I am sure Matthew would like to know the original stakeholders for the Balmain mine lived nowhere near Balmain. A bit like Adani, but more Old World. London to be exact.

And Matthew, somebody always has to pay the Piper … maybe your children and our grandchildren.

Hawke in the Willow

When I was seriously involved in politics, I met Bob Hawke once when he was Prime Minister and was very impressed and flattered that he knew who I was. He was one of those politicians who knew both faces and reputations. He was on a different rail line to me.

However, one night years later my wife and I with a few friends were celebrating our ninth wedding anniversary. Now the ninth wedding anniversary is willow for all of those who are not obsessed in knowing what to give on a particular anniversary. Needless to say, I had just presented my wife with a cricket bat at the celebratory festivity in the Flower Drum restaurant in Melbourne, when in walks Bob and Blanche with a few friends, including the late Martin Crowe, then recently retired after captaining the New Zealand cricket team.

Given that the last time Hawke had greeted me like a mate, and with a reasonably high sherbet level I took the cricket bat over to them after they had settled in but before any of that elegant Flower Drum Chinese tucker had started to flow. I asked Bob as a mate to sign the bat for my wife giving him a potted history of why I had a cricket bat in a posh Chinese restaurant. He obliged. Blanche signed too. Hawke however looked at me quizzically given that it was a unique experience to be asked to autograph a cricket bat in such an environment. However, that was the personal touch of the man.

Then as I thanked them and was walking back to our table, the owner of the restaurant insisted on signing it too.

As we were walking down Little Bourke Street after dinner, my wife had the cricket bat over her shoulder, and somebody in the street yelled out, “Melbourne is not that dangerous, luv.”

Mouse Whisper

Heard in the Manolo Blahnik industrial boot store in Paraburdoo.

“So if blue is Liberal and red is Labor, when they come together in the political centre do they mix to form purple? The Political centre must be called the Purple Patch then.”

By the way, just back from Mousehole where the last Cornish speaker, Dolly Penteath died in 1777. Her last words were defiant. “Me ne vidn cewswel Sowsnek” – “I don’t want to speak to English”.

Modest Expectations Nein

Hey wait a minute. Sure, most people didn’t predict the result of the election. I thought we had 1972, although I had reservations about Shorten and his lack of charisma and the fact that 1972 did not yield the landslide that Whitlam had hoped for given how ghastly McMahon was.

Plainly Morrison was underestimated – the child actor with the perpetual grin prevailed … sort of.

But hey again, wait a minute. The language is going a bit over the top: “crushing victory”, “blood bath”, “horror night”. Hardly. What has happened is the media Kommentariat have got it wrong – to a degree.

Having said that, even before the election, Shorten, although losing a seat in South Australia in the redistribution was gifted another seat in the ACT and three in Victoria– one new and two previously held Liberal Party seats. In other words, Shorten started with a three-seat advantage.

Unlike Whitlam who won five seats in his home State, Shorten lost, if you don’t count the new seat of Fraser and the two notionally Labor seats as gains, one in Victoria. My pre-election line: “And tellingly Shorten comes from Victoria” begged a reply. I however did not expect “It won’t matter. He’s a loser.”

And the ironic final blow was that Shorten has lost Bass, the seat where the Beaconsfield mine is located and where he started constructing his national profile in 2006.

Morrison has eked out a victory, with Dr Faust very much clothed as a banana bender or cane toad – whichever description takes your fancy when describing our Northern State. He now has 24 members from Queensland (25 if one counts Bob Katter) in the House of Representatives with their de facto leader Barnaby Joyce just across the border.

Morrison is probably relieved that he has lost Abbott, because he does not have to find a place in the ministry and the Falangist right have lost their parliamentary leader.

Morrison should however be mindful that all three of the latest Coalition Prime Ministers have lost their seats, one by resignation and two at elections. Not a good precedent.

One significant gain is that Arthur Sinodinos has regained his health in his battle with cancer. How long he is in remission will be critical for Morrison. His exchanges with Penny Wong were exquisite on election night. Sometime one sees elegance in politics and how two people with differing views can accommodate the other.

Morrison may have heard his Brisbane colleague Dutton say, “This is the sweetest victory of them all”, repeating the quintessential Keating paean to hubris. As Keating found out three years later, Nemesis is the enemy of hubris. However, Queenslanders are a distinct breed. Having worked and travelled widely in Queensland, I recognise that it is useful to have a friend or two there, especially if these friends are close to the land. They give one a jolt of reality, and yet if I were Morrison I would prefer those jolts to be spaced and constructive.

The Victorians put away the cricket bats that I thought they would produce, and have given the Coalition the benefit of the doubt. However, there were big swings in some of the Victorian electorates and Mr Frydenberg will be acutely aware that he has a restless constituency, with cricket bats still at the ready.

And listening to Barnaby Joyce post-election where he seemed to be under some influence – perhaps alcohol – then the next years are not going to be pleasant. Likewise for Queenslanders, who have been engulfed in extreme weather changes and with a decaying asset in the Great Barrier Reef are hankering for more jobs. To them Adani spells Employment. Again we shall see.

Quilpie

I love going to the Queensland Outback. It reflects the Australia of my childhood.

One week a couple of years ago, we stayed in Quilpie in a small motel at the end of town, overlooking the railway track. Fresh water was limited in the town and so we bathed in the motel shower – hot bore water with a distinct sulphurous smell – in other words dilute sulphuric acid. Breakfast was as I remember in the classic fried eggs and bacon on white bread toast. Could have added sausages.

In the evening we sat around having a beer or two with the fettlers whose job was to maintain the railway out to Quilpie and who were staying at the same motel as we were. Mind you, they said, there was only one cattle train a year between Charleville and Quilpie, but the line had to be maintained. An empty freight train comes out from Toowoomba once year to pick up stock and then generally goes back empty, just so the Queensland Government auditor presumably can be informed that the line is still in use.

And yet here is a decaying railway line passing through one of the major black opal mining areas in the country. There is a shop with the most exquisite black opals. Beyond – at Eromanga – there is dinosaur country with a fully-fledged palaeontology setup. In this area, as in Winton to the north, there is a trove of dinosaur and megafauna skeletons. The accommodation here is first class, and the shower water is drinkable.

One only has to look at the media to see how popular tourist rail journeys have become worldwide, and that journey out to Quilpie from Toowoomba is far from boring. After all, how many places in Australia are a refuge for bilbies, as is the Charleville railway station. Tourism Queensland: good for jobs; good for the environment; and after you have renovated it, the Great Western Railway would be a great attraction, the basic infrastructure is there – Michael Portillo might even be induced to ride it.

Pity about the railway line from Charleville to Cunnamulla. Just south of Cunnamulla it was blown up in one of the biggest explosions ever in Australia in 2015 when a truck carrying ammonium nitrate exploded on the Mitchell Highway. No-one was killed , but the explosion has left an impressive hole – as if a meteorite had hit there.

However, the problem is that Queensland politicians only seem to think of mining and thus predictably not much happens to this rail line beyond Chinchilla, predictably a coal mining area.

But Queensland is not just coal. It is so much more!

As Miss Bingle may have called out: “Why the bloody hell don’t you realise it?” (With appropriate acknowledgement of the Prime Minister when he ran the Tourist Commission.)

Dental Health

The re-election of the Coalition will mean that the Dental Health of the nation will hardly rate. The Prime Minister said it was a State matter. It is not. It is a Constitutional responsibility: *51(xxiiiA) The provision of maternity allowances, widows’ pensions, child endowment, unemployment, pharmaceutical, sickness and hospital benefits, medical and dental services (but not so as to authorize any form of civil conscription), benefits to students and family allowances. (My underlining)

I always remember in the generation before me that in the working classes when a woman became engaged to be married there was a strong likelihood of her having all her teeth removed, if they had not all rotted away already.

The problem in pre-antibiotic days, the mouth was a pool in which the teeth harboured nasty germs and hence was the fountain for systemic disease. If it were not teeth it was tonsils. Removal of both followed. And even further back, in the generation before, diphtheria lurked.

This is no longer the case so long as dental hygiene is maintained and there is fluoride in the water.

My premise is that fluoride should be added to every town’s water except where there is already enough naturally occurring fluoride in the water supply, such as at Quilpie in western Queensland. Another problem of course is that most bottled water does not contain fluoride. It should be mandatory, but as with the dairy industry products to Asia reported elsewhere, science bends to the voodoo.

In fact there are 48 councils in Queensland where there is no fluoridation of the water supply i.e. 68 per cent of the Councils representing 800,000 people. Councils in the more populous regions are fluoridated. So with Queensland politicians in the ascendency, water fluoridation is not likely to happen unless there is a will to do so.

As I have foreshadowed before – and as I have done for years – I shall continue to pursue the need for a national dental scheme, drawing from the experience of Medicare, remembering that Medicare was once strongly opposed by the medical profession, the Coalition and others, even Queenslanders.

The Forgotten Warrior

Mention of Medicare reminds me of someone else. In all the posthumous idolatry of Bob Hawke, we have forgotten probably one of the real statesmen – that rare person in politics who was courteous, intelligent and who probably unleashed Paul Keating onto the wider stage. He was the policeman from the seat of Oxley. He is a Queenslander and his name is Bill Hayden.

When all the plaudits are being handed out to Bob Hawke about Medicare, the real architect was Bill Hayden with the introduction of Medibank, a decade earlier. He resurrected the Australian Labor Party as successfully as the right of the NSW wing of the Party buried him, and of course as they say, the rest is history.

Apart from a reference to another Queenslander, the drover’s dog being able to win the election, Hayden did not carry on like that later Queensland incumbent who was rejected by his Party. Hayden continued his career as Minister and later Governor-General.

He undoubtedly would have pursued the reforms that Hawke instituted, but he would have renegotiated a foreign policy, which would have made us less of a United States satrap. But then of course we shall never know the validity of that comment. Further, I doubt whether Hawke would have behaved as Hayden did if, instead of winning, he had been defeated in his 1983 quest to be leader of the ALP.

Bill Hayden lives on. He is a great Australian.

Twirling Tea Leaves – A Tempest in my Teacup

I am a bit worried about all this fuss involving a gentle giant rugby union player called Israel Folau.

He posts this notice: “drunks, homosexuals, adulterers, liars, fornicators, thieves, atheists, idolators – Hell awaits you”.

Now do we presume that Hell is currently empty of such diversity? If not, it could just as well be a description of the population of the Eastern suburbs of Sydney – or for that matter anywhere else in Australia where there is a heterogeneous population of people.

    • Drunks – we do not seem to have a problem societally there.
    • Adulterers – we have no-fault divorce
    • Liars – most politicians led by Trump
    • Fornicators – see Adulterers-in-training
    • Thieves – the banking Royal Commission disclosed how acceptable that is – presumably Hell is also in the Cayman Islands.
    • Atheists – doesn’t matter, they don’t believe in Hell.
    • Idolaters – my objection is stated below.

I do not subscribe to the Dante interpretation of Hell.

It does not interfere in my belief that there is a God that I do not see demons with tails and carrying pitchforks as potential eternal companions. I happen to believe very much in the Trinity and am comfortable with the Anglican High Church interpretation.

So am I an idolater “awaiting Hell” because I believe iconography a very important component of my belief system? The Christian Church over the centuries has been racked by the Iconclastic, with whom I disagree. You see iconoclasm in the effect that Cromwell and his ilk had on England. Quoting David Freeberg on a different period: “At the end of the sixth century, Gregory the Great threw the pagan idols – that is, the statues of classical antiquity – into the Tiber. They were idols not only because they were beautiful and therefore seductive, but because they were the replete symbols of a corrupt religion, only recently hostile to the true one.” Thus it is difficult to work out who is the Folau idolater.

However, I am not distressed about being sent to Hell because Israel has listed me. Should I exhort the non-iconoclastic cohort of the Christian Church to rise up against the iconoclast Folau? The answer – “No”.

So what is the fuss all about?

It could be argued that Folau is being made a martyr for his religious beliefs. I cannot detect any hatred, just an assertion about Hell. Hell may be on the Planet upon which we live, but show me the actual workplace please.

There is another worrying, less metaphysical aspect. Qantas sponsors Rugby Union and I wonder would this pursuit of Folau be so great if, for instance, another Alan, Alan Jones was the head of Qantas.

The Emblem of Rugby Union Australia should be changed to a Teacup.

Mouse Whisper

And to my Boss Blogger who is always asking me for smart quotes.

“You picked the wrong electorate – you said Corangamite would be the bellwether electorate, should have put the bell on the Chisholm sheep, you dill” … as whispered from Mousehole in Cornwall, where I am having a glorious time with all me mice mates.

Modest Expectations Ate

Bob Hawke has died. A cricketer, he would have been proud of making 89. Unlike Whitlam, he had a very good first XI. Some were brilliant. He did not make the same mistakes as Whitlam. He was not divisive; as with all good captains, he gauged the strengths and weaknesses of the opposition, and that of his own side. He had at least one dictum – he exerted attitude change in his own party such that the old time union collective thinking in which he had grown up, was changed.

However, when you go against your normal working person constituency, no matter how beneficial that might be for the Australian community, paradoxically you increase the power and influence of those elements which remain emphatically opposed to your reforms and who, over time, would seek to distort or destroy those reforms.

In time others may pore over the Hawke legacy and I for one wonder what he would have done for Australia if he were of the current generation and waiting for Saturday.

A Surfeit of Coke

Talking of mortality, one option that has not been widely canvassed about the current US Presidency is that Trump may die suddenly in office. If it is true that he drinks 12 cans of Diet Coke a day, has a diet of fast food and is so obviously overweight suggests that he is a walking health disaster waiting to happen.

In his latest medical history his height is recorded as 6ft 3in, but on his medical record when was being drafted into the US Army the record says 6ft 2in. Has he grown an inch as an adult? Really? Look at his shoe heels. Already obese at his recorded 243 pounds, how does anyone know what his real weight actually is? That missing inch plunges him further into the Obese.

Of course we do not know about his health status any more than we know about his tax returns. He obfuscates from his sandpit. It is his whole strategy to create sandstorms.

However, the one thing that Trump cannot make a deal about is his physical health.   He can only hope that the drugs will deal with his atheroma, not to mention what appears to be a cancer-prone diet.

Judging by the media reports there is a chorus of learned doctors or psychologists who obviously believe he is mentally impaired despite the protestations. His bizarre behaviour is just a quirk of his personality – a legacy of his early childhood his apologists say.

Trump prefers Diet Coke, and his daily consumption of it is extreme. According to the pundits, the excess drinking is linked to mood swings and dementia. As we all know, because he tells us, he is a cohort where n=1. He may be thus unaffected and the mood swings may be due to other factors, but the world ought to know. It is reasonable to know the mental state of a person who has control of the nuclear button, and what has caused it.

Is he mad? It is a question that publically the world would not answer through its current beige array of politicians. There are those politicians who prefer the Trump flamboyance – a man of many mental colours. There is that state of Munich delusion that one can cuddle up to Trump, know this man’s mind, and get him to sign a promise to be a “good, predictable boy”. Some have tried to put a political straitjacket on him – to be his great friend and mentor – to their cost. That is his art of the Deal. It costs you, not him!

Well, his handlers could deprive him of Diet Coke and see what happened, and see if the twitter finger stops twitching and rationality prevails.

However he is well past satisfying Koch’s postulates. The Diet Coke could have replaced his blood and no longer would he be like any of us mortals …

He is the Child Trump caught up in The Rapture. The Rapture is quoted as a doctrine that at the return of Christ, all believers will be caught up, “raptured”, to meet the Lord in the air. The bodies of dead believers will be resurrected, and all believers, living and dead, will be glorified. To the believers, it is a passport to immortality. That is the Child Trump constituency, who may call him not King but at least Duke.

The problem as with Mr L Ron Hubbard, whose disappearance galvanised a whole generation of charlatans, if he dies now as a demonstrably unhealthy Old Trump, his followers may believe the Child Trump is not dead. He may become a cult for the Enraptured, setting up shrines with figurines of the dear little child with golden hair and red baseball cap along the highways of America waiting for him to come again.

However, that is probably better than that of him never accepting the American people’s verdict saying at the end of 2020 “You’re fired!”

Shoulder replacement – The Anatomy of Medical Advance

I have a worn-out body. A major road accident over 30 years ago did not help.

So I was attracted to an advertisement in a major metropolitan daily for complete shoulder replacement. The advertisement is cast in a way that suggests it is just the thing for a worn out shoulder. Out with the old; in with the new. Like repairing a car, but with a car you at least can get a written guarantee.

However, when one is embarking on a major operation, such as a shoulder replacement, it may go well. You, the patient, if it is a new procedure, may become the poster person for the operation, the one the hospital and surgeon wheels out when boasting how great you, the Result is. You are the Positive Result and are allowed to say a few words, the surgeon performs the benediction, interviewer sums up from the media handout – and the camera is turned off.

The problem is that what the advertisement lacks is setting out the complications, which are rapidly becoming the small type to protect the surgeon and which frankly most patients do not want to hear. There it is in small type at the bottom of the advertisement: “any surgical or invasive procedure carries risk. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.”

However, if you get a complication with such a complex operation as a shoulder joint replacement, you are looking down a long corridor of pain and disability.

I consulted a shoulder surgeon some time ago, because that is how specialised orthopaedics is. This bloke was very frank. Shoulder surgery was difficult; unpredictable results; the surgeon he would recommend is “very good”. However, in the end it is how much knowledge I, the patient, have in making an informed decision. I weighed the evidence up, and said I had decided against an operation on either shoulder.

Outcome is one matter for making an informed decision, especially as increasingly surgery is leaving foreign material in your body. Some is fine; some is not and when a technique is new, how do you know the likely outcome? The answer is you, the patient, do not. Trust in the integrity and skills of the operator are paramount.

But not quite! What was absent from the advertisement was the cost.

Let’s list them.

There is the cost of the hospital stay – everything down to the nametag. The cost of the surgeon – the enquiry about whether there was an assistant and why – and then the anaesthetist. That person is often forgotten in determining the cost, because he or she is the person the patient sees fleetingly.

Then there is the cost of rehabilitation. Because there is a belief that the surgery has a magical effect similar to laying on of hands, the need for rehabilitation may be underestimated. Try to take a middle course and ask, even if it means flattering your particular surgeon that “it could not possibly happen with him or her at the ready”, get a price which includes a contingency item for the costs of complications.

The solution – make it mandatory for prices to be displayed, including the guaranteed consumer floor price – that is, the Medicare benefit. This makes the shortfall starkly obvious.

Then given the notorious asymmetry of information, it is suggestive that there may be a case of brokerage – where those with knowledge negotiate for the customer, without the emotional stress of having the condition. Needless to say, there is a business model to be developed where, through brokerage, the asymmetry in health information can be corrected – as long as the process is uncontaminated, as the mortgage brokerage system recently was shown to be.

It’s Time – The Bubble rhymes with Trouble

One has the feeling that Victorians are going to go after Morrison and his crew with cricket bats. Morrison is not the right fit for Victorian voters. The hillbilly persona does not wash well in Victoria especially as he so clearly identifies himself as a New South Welshman, and the fact that Frydenburg is the only Victorian of note left standing says a great deal about the state of the Liberal party. The problem is the myth of a liberal Victorian has been blown away with the rise of the populist far right in Victorian Liberal politics, since the Kennett accession in 1990s.

The situation uncannily resembles 1972 – a NSW Prime Minister and a Victorian Treasurer. However, the Leader of the Opposition was Whitlam in 1972 – New South Welshman, secured six seats in NSW, the greatest number. His “It’s time” introduced the charismatic presidential-style campaign. Despite everything, Whitlam did not win in a landslide. In fact, Labor lost four seats in Victoria, one in South Australia and two in West Australia. However, it picked up seats in Victoria (net two), Queensland and Tasmania.

Snedden was never in any danger of losing his seat of Bruce in 1972 and Frydenburg should be in the same position. But is he? The bellwether seat is Corangamite, long a Liberal stronghold but for some time marginal with the spread of Geelong to the west counterbalanced by the shift of affluent retirees to places like Torquay and Barwon heads. If Corangamite is lost, so is Australia to the Government.

And tellingly Shorten is a Victorian.

If the Labor party wins big in Victoria, and takes seats in New South Wales and South Australia, what happens in Queensland, Northern Territory and Tasmania becomes irrelevant in the numbers game, except in perpetuating the cleavage in Australian society. This cleavage is not more starkly demonstrated than by the Green and Labor advance in the northern coastal regions of NSW. However, go across the border into the Gold Coast and one is in solid Liberal Party territory.

One has to realise that love of a member in Queensland is inversely proportional to the despisal in the “Mexican” States. Listening to a highly intelligent North Queensland academic referring to the member for Dawson as “good ol’ George” is confronting for those of equal intelligence without the privilege of being baked in the tropical sun.

However, there are several differences in the political scene now and in 1972 and that is the rise of the Independents. The Independents are fashioning themselves into a party of the Centre, freed from the constraints of the Creationists, Falangists and Rural Socialists, that coalition within the Coalition. One of the important features of this election is to see how well the Independents perform – one observation is that they seem to do well when the incumbent member is so appalling that anyone somewhere decent becomes electable.

The bellwether here is Kerryn Phelps. She profited from the clumsy dumping of Malcolm Turnbull and the fact that she had a high profile. However, the problem with her high profile is that she has a great deal of baggage and given her time as President of the AMA and the nature of her support base at that time, it would be a surprise if she has maintained that support base. Considering that her opponent has had more time to assess her, is a former DFAT charmer, is as likely to be as smooth as Dr Phelps is spiky, then she has a challenge. If she holds the seat, then again one can guarantee the swing is on against the Government.

However, the lessons for the government are undoubtedly how this country goes about climate change, how it participates in the Coalition of nations in the South Pacific, how New Zealand and ourselves become outspoken on the matter – just as I would remind the reader that 20 years ago we were outspoken about getting nuclear testing by the French out of our backyard swimming pool.

So I can predict, but I am notoriously bad at it. However, irrespective of whether Morrison or Shorten is Prime Minister after this weekend, any future government worth its reputation should realise that Australia is the joint Guardian of the South Pacific and Southern Ocean and Antarctica – and that is only the start. Trade and jobs become irrelevant if the Earth becomes uninhabitable.

And that, Mr Morrison, is not a Canberra bubble!

The Curse of Pre-polling – The Loss of the Democracy Sausage

I have voted. It was very convenient. It was easy to park the car near the hall. No waiting time. I met both the Greens and Liberal candidates – both nice guys. However as it is a safe Labor seat, you are more likely to meet Elvis Presley than the Member.

Pre-polling is so popular, since most Australians view voting on the Day as one step from having to go to the dentist. Having to run the gauntlet of those trying to shove a piece of paper into your hand and then having to queue, in the end, everybody will have exerted their preference and have voted by Election Day. In several elections’ time, if this trend continues, Election Day may become the Day that nobody came. So there you are, with the picture of politicians with a heavy countenance as they have when they are voting for an increase of their entitlements, in bilateral solemnity agreeing to now decrease the pre-polling time in the future. After all, one has to protect the “democracy sausage”.

Mouse Whisper

Heard in the Louis Vuitton emporium in Pooncarie as one stockman said to the Vuittoneur as he was looking through the range of outback portmanteaux:

“Why is it that politicians are always having Visions? Who do they expect to see? And why – if you can have a Vision of the Future – is it not acceptable to have a Hallucination of the future? Makes as much sense.”

 

Modest Expectations Septimus

Jeff Kennett recognised during a trip to New York that the colour yellow stood out in the visual spectrum. He had seen the New York taxis were all yellow and they stood out somewhat better than the various muted colours of the taxis in Melbourne at that time. So he decreed the yellow taxi for Melbourne.

Clive Palmer has recognised his party’s colour stands out like wattle in springtime.

Mr Palmer is a clever man. The hoarding owners know that and make him produce the cash before they agree to display his message.

On the hoardings Mr Palmer’s image appears to be photo-shopped so he looks much lighter and younger than he actually is – he is a very heavy gentleman and sometimes when he was captured asleep in Parliament, I wondered whether he had Pickwickian Syndrome named after the fat boy in that Dickens novel who was always falling asleep.

But while the heavyweight Mr Palmer is barely on view in person in this campaign, his messages are there: “Fast Trains”, “More Wages”, “Cheaper Energy”, “Free Cake” and they have apparently resonated with some in the electorate. Clive has perceived the end stage of the information revolution; photo-shopped images and two word policies. “Clive Palmer” itself is a policy.

Mr Palmer has been underestimated. His Chinese partners have found that out. His nickel workers have found that out – shimmering generosity followed by real famine. It is now up to the Australian electorate not to overestimate Mr Palmer.

And remember! Yellow is also the colour used for biohazard warnings.

The Psychopathology of Politics

I once toyed with going to Yale to undertake a doctorate in the psychopathology of politics. It was the early 1970s and I had come under the influence of Alan Davies, the then Professor of Politics at the University of Melbourne. “Foo”, as he was affectionately called, continued to influence much of my thinking in this area, and enabled me to write about it, getting some currency in the 1970s when I was considered to be “someone of promise”.

I didn’t go to Yale, but my interest in politics remained. I have two aphorisms that have stood the test of time: “all politicians proceed from a basis of low self-esteem” and “politics is the systematic organisation of hatreds”. The first is attributed to Harold Lasswell, a major American political theorist, and the second to one of that political Adams family which yielded two American Presidents.

However in the potpourri of personal politics where the pathology lurks, it is the ability to see yourself through the eyes of the viewer, which is a saving grace. Jacinda Ardern has that skill. She is an art gallery of images; so many images she is able to project and yet remain that singular woman I described in an earlier blog.

On the other hand, one thing about Bill Shorten is that he doesn’t have the intuitive sense of image that Ardern has. If I were his adviser, every time I saw him jogging I would tell him to jog away from the media lens. Or if he insists in exercising to find a medium in which he does not look like a duck, paddling along, paradoxically without a bill. Watching him jogging, it’s hard not to expect him to quack. But then again when you’ve got a critic like Murdoch, who presumably was not called “Boof” for nothing at Geelong Grammar, then your jogging gait is only a small irritant.

Morrison understands this image aspect of politics much better than Shorten. Whether his “aw shucks” approach has worked, we will find out in about a week’s time if the independents don’t cruel the pitch. Morrison abandons images that don’t work, like his “happy clapper” church routine. He is the ultimate pragmatist. Research obviously is telling him that the baseball cap is working. Remember Turnbull venturing into Queensland with his brand new Akubra? He was referred to as “that tent peg” – wide hat thin body.

You don’t want your audience laughing at you; only with you. This is another aphorism and one of perspicacity in being able to tell the difference.

Of Australian politicians, Penny Wong is wonderfully deft in a way that is not Ardern, yet from the same school; those who can stand outside themselves and see their image as others do. Her minimalist approach to herself is extremely effective. 

Dental Benefits

Stephen Duckett, well remembered in a past life as the Raider of the Lost Cookie Jar, has instigated a discussion on one of the most neglected areas of Australian politics – establishing a national dental health scheme. There was a somewhat insipid yet positive response from Shorten but as far as I can see nothing from the Liberal Coalition.

The paper is timely and whether you agree with the detail or not, it is important. However, it is 67 pages long and I don’t intend to critique it – rather it is useful to emphasise a few points and place the accent on different areas.

First of all, let us say that the advocacy for a dental benefits scheme, along with a medical and pharmaceutical scheme, has never had a champion in the Australian parliament. In fact I cannot establish whether there has ever been a dentist in the Australian Parliament.

After the Constitutional amendment in the 1946 referendum, the ubiquitous Earle Page, (a rural medical practitioner in his own right) championed the adoption of a national medical scheme, which was established in 1953, and massively updated following the Nimmo Report in 1969 with first Medibank and then Medicare.

Yet government policy has been silent on a universal dental policy. First of all, organised dentistry was opposed to it as they saw it as unnecessary government intervention in affairs of the mouth.

However, there are a number of matters that need to be addressed before the detailed question of coverage and affordability can be considered.

The first is the matter of fluoridation. Australia has a vocal fringe group opposed to fluoridation of water. To these people, it is yet another of the many tentacles of the Giant Conspiracy. There are many rural local government areas, particularly in Queensland, that do not have fluoridated water.

It is not only the Conspiracy Theorists, but also some Big Business that wishes to thwart fluoridation. I experienced this side of the debate where a community, in a public meeting, supported fluoridation without dissent, but the largest industry in the town – Murray Goulburn, which was not present at the meeting – went direct to government to say it would not put fluoridated water in the milk products. The reason given was that the Asian market rejected fluoride in milk products.

The community decision was ignored. Business triumphed over public health. Until a separate water pipe bringing unfluoridated water was provided at taxpayers’ cost to Murray Goulburn, the children of the Victorian township of Cobram unnecessarily forwent fluoridated water for nearly a decade after the community decision.

The point is that any universal dental scheme must take into consideration the requirement for universal fluoridation in the water (with the only exemption being those communities that have the recommended level already naturally present in the water supply), and not to be prisoner to the vagaries of some local governments. This whole question of national fluoridation needs to be addressed before benefits are paid for dental treatment.

The second consideration is the Australian Constitution and the question of “what are ‘dental benefits’?” If the dentists had encouraged the provision of a dental benefit scheme from the outset, then the definition of “dental” would have been clear. However, there are a number of health professions that have “dental” in their title. Not are the least of which are “dental hygienists”. These professions with dental in their title could argue that their services should be eligible for benefits under the Australian Constitution. Unlike “medical” which has been defined, any profession with “dental” in its title could be recognised as an independent profession. For instance, the Australian Health Practitioner Regulation Agency (AHPRA) lists dental hygienist, dental therapist and dental prosthetist.

I am a great supporter of a universal dental scheme, but I am also opposed to shovelling out money without consideration of the consequences. This will be a recurrent theme as my blogs keep piling up.

A Child Care Parable

There once was a young post-graduate student, who was pregnant. She had graduated in medicine and then there were restrictions on pregnant women being interns in hospital. Some reasons had a trace of validity, but most were the consequence of male prejudice in a male dominated profession. Her husband was newly graduated in medicine but the annual wage for an 80-100 hour week was about 1,000 pounds including his board, but not hers. She remembered escaping being machine-gunned by a low flying American plane in the war. Although a small child in the street in Ljubljana, and the plane was so low she saw the face of the pilot, who aborted his strafing run when he saw that it was a child. He was black.

She was thus of migrant parents who had been refugees from central Europe. So her upward progress had been though determination and sheer hard work. She wanted a career, but she also wanted her child to be looked after in a safe environment in which she had a role in assisting. So she started a group with friends, who initially raised funds by serving coffee and biscuits at the university theatre. Eventually she secured a premise in an old Jewish school in the inner city near the university.

Then the battle for recognition and viability started – making ends meet and battling a government department headed by conservative male bureaucrats and complicit older women, whose model was the wartime nursery. These were set up so that women were freed to work in the factories and elsewhere. After the war, it was assumed women would know their place and retire behind the white picket fence. Those who wanted careers could resort to parents or nannies.

A fire had occurred six years before in a childcare centre, in which a number of children had died. Regulations were tightened, some justified, others less so. For instance, there needed to be a dining room with spatial dimensions of ten square feet for the first ten children and then eight square feet per child after that, presumably on the basis that the more children there were the smaller they became. Really?

Attitudes hardened and the idea of providing for parents to run a co-operative was resisted. However the co-operative was formed with parents as directors and the government reluctantly provided funds to renovate and equip a centre in accord with their strict regulations.

Parents paying fixed term fees from one to five days a week solved the question of financial certainty and hence assured financial viability.

The Centre had a trained registered nurse with child and midwifery qualifications as the executive officer and a kindergarten teacher, and others trained to various skill levels, both full time and part time, meeting the requirement for one staff member per five children for infants and one for fifteen when they were at kindergarten level. I use the word “skill” because education here requires in-service training, more males, and adequate salaries. Of these aspirations, she never enticed a male onto staff. Otherwise she was very successful.

She was adamant that all the staff be trained and cared for by the executive. The turnover rate as a result was low.

She had two sons, one who went into care at six weeks. They are now in their fifties, successful in different fields, each with a working spouse and each with three children.

Her advice even now could help a government intent on bringing in a childcare scheme, free of rorts. Subsidising the for-profit sector without demonstrable parent involvement is not the right business model.

The Centre she set up is still going strong.

Mouse Whisper

Experienced at the lunch table at the Magill winery in the suburbs of Adelaide when asked whether she preferred to be called “woman” or “lady” the young waitperson responded: “established female”.

Modest Expectations Fathom

This question may be seen as a bit odd for those who don’t have a father who was a young man in the 1930s, and I say father not mother – not to be disrespectful to women – but as a sign of the times in the 1930s.

“Which side were you on during the Spanish Civil War?” Did you back the republican government or Franco? It is a double-barrelled question, because that war can be interpreted as a battle between fascism and communism for two reasons. Hitler was testing out his military might, not only on the Republican army but also the Spanish citizens and Stalin was making sure, in the guise of supporting the Republican cause that he sacrificed socialists and anarchists to his form of authoritarianism, laughingly described as communism. However, the Republic was the legitimate government.

The Spanish Roman Catholic Church supported the Franco insurgency as also did the Church in Ireland. An Irish brigade was formed to fight for Franco. It was so ill-disciplined that Franco sent them home. However, the Irish connection is a recurring theme.

Most of those men from other democratic countries, including Australia, who went to fight were on the Republic side. The only recorded Australian who actually went to fight for Franco had a change of mind and he was killed while flying for the RAF in 1940.

However, it is a textured question. The cloth for the Spanish Civil War was woven years before. The Italian Futurist movement, which glorified war and dismissed history as bunk, was hidden beneath its paintings and poetry that provided the warp for the rise of Mussolini. Disaffection and perceived decay of the Weimar republic among other factors led to the rise of Hitler in Germany.

This was manifest not only in Australia, but as the New York Times noted this week in an editorial: In the 1930s and the 1940s, The Times was largely silent as anti-Semitism rose up and bathed the world in blood. That failure still haunts this newspaper.

A young Sydneysider, Phillip Morey, experienced its rise in the early 1930s, when he recognised the Fascists with that expressive word “rodomontade”. Below is taken from a memoir written about Philip’s experience:

He loathed the fascist New Guard that had been cavorting around New South Wales at the time. He considered the rhetoric of Eric Campbell, its leader, to be a “bombastic rodomontade”.

Philip remembered Campbell from two years before when the antics of Captain De Groot on Saturday 19 March in 1932 had initiated a confrontation with the Lang Government. Not that Philip had much sympathy with Jack Lang …

Francis De Groot was an Irish fascist who lived on his own bravado. Campbell was the populist Fascist — organiser of clandestine training for his New Guard for whom Mussolini in Italy and this new fellow Hitler in Germany seemed to have some answers to the world disorder.

Philip was determined that he was not going back to this world where the colour of the shirt seem to dominate — whether they were “black shirts” or “ white shirts” — Philip had thought Campbell’s posturing all very puerile — playing soldiers with his band of followers in various parts of Sydney. He had heard just before he’d left that they had been drilling in Killara, further up on the North Shore. Campbell had even issued a directive on street fighting — how to march with fixed bayonets and how to clear buildings with grenade, tear gas and rifle.

The text rings true when you see the antics of the extreme right today. The current mob has the ethnic hatred of Eric Campbell and later Eric Butler with his League of Rights. Then the target were Jews, and there is still residual anti-Semitism, but Muslims are now the prime target, and unlike the pathetic followers of Eric Campbell, their spiritual descendants have access to murderous weaponry.

How more insidious are the inheritors of Bartholemew Augustine Santamaria, in the 1930s, a rising intellectual within the Labour movement and protégé of Archbishop Mannix, once an avowed member of Sinn Fein? Santamaria was an avowed admirer of Franco, the only difference between Franco and Mussolini was that Franco stayed neutral during World War II and died in bed.

The Santamaria playbook mimicked his perceived communist foe in the union movement. He created industrial “Groups” within trade unions, backed by a secretive “Movement” designed to plant Catholic operatives in key positions throughout the Australian Labor Party – only now they are embedded in the Liberal Party.

But back to the question of 1936, how many of those who now support the heir to the Movement in the Sydney Institute would have voted Franco if they had been in the time of my father? However, I do not want to limit that question only to that select few – anybody can answer.

And the relevance? Franco was a tyrant who clothed himself in the Roman Catholic Church – currently in the western world, we would have one would-be tyrant, who clothes himself in fundamentalist creationism and another in the Orthodox Church. They are most prominent but not potentially the only ones. Franco is their shroud.

The “textured” metaphor is apt.

And my father? I believe he would have voted for the Republic, but then I never asked and he was unpredictable.

Fanfare for the Common Man – A Reflection on Anzac Day

Across the water from the small township of Lubec, Maine is Campobello Island in Canada. I have crossed the bridge to the island. Campobello Island is synonymous with Franklin Delano Roosevelt. Roosevelt smiled. Roosevelt exuded optimism. He was also a cripple, struck down by poliomyelitis one morning on this most beautiful of islands. Yet he strove for independence.

Until the ghastly event in Christchurch, I thought I came from a country where to “bare arms” is to get down to work with my fellow citizens. Yet I live a country where our major commemoration is a World War One disaster at Gallipoli and our national day is called by some “Invasion Day,” when Great Britain dumped a bunch of their unwanted – convicts and marines – in a desolate place called Botany Bay in 1788. Despite its apparent vigour, Australia is a country rooted in pessimism.

By contrast, the USA national day celebrates something more than putting a British foot on a distant shore.

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

I have seen much of Australia.

But then I have been privileged to roam the United States too. I have sponsored two musk oxen called Amethyst and Pixie Stix in Alaska. I have sat in the South San Franciscan courtyard of Genentech just after it had started listening to the late Bob Swanson’s aspirations and then writing about it. I have eaten king salmon in Salem, Oregon, and crab in Sabine Pass, Texas – both sublime experiences. I have stood at the door of that miracle of Minnesota, Mayo. I have gazed at Mount Rushmore and know now why those four presidents were carved. I have wept at Shiloh. I have stood in the wheel ruts of the Oregon Trail in Douglas, Wyoming. I have joined in a march to the San Francisco Tenderloin on January 15 to honour Martin Luther King. And oh, so much more!

The United States in all its diversity has been my energiser from the first time I ever went. Even in adversity, this country has always exuded optimism, irrespective of Trump.

“Make America great again!”

What rubbish! America remains great so long as it never lose its Smile, it never loses its Optimism; but above all it never loses July the Fourth and its Constitution.

If we want to replace January 26 as Australia Day…

“The first celebration of Wattle Day was held on 1 September 1910 in Sydney, Melbourne and Adelaide. Plans in 1913 to proclaim the wattle as a national emblem and to celebrate Wattle Day nationally were interrupted by World War I, but wattle remained a strong symbol of patriotism during the war years.”

This Google entry sums up Wattle Day succinctly.

One can only be struck by the colours of the Australian countryside in early spring. The yellow displayed is not only because of the wattle but also because of the canola in the broad acres and broom along the roads – there are so many yellow wildflowers but elsewhere it is the yellow of the prickly gorse scourge. So every symbol has its downside.

Intermingled with these patches of yellow is the eucalyptus green countryside – the wattles themselves, the gum trees and then there are the green pastures and cereal crops yet to ripen.

And when the land is so green and yellow should this be the time to remember our country with a national day? After all, the Argentinians, whose national day is May 25 say you can look up into the sky and see their flag. In September we would have the option of both looking up to see the Southern Cross but also to see our national colours across the land.

Even D.H. Lawrence in his rather dismissive novel about Australia, Kangaroo, wrote: In spring, the most delicate feathery yellow of plumes and plumes and plumes and trees and bushes of wattle, as if angels had flown right down out of the softest gold regions of heaven to settle here, in the Australian bush.

And what a time of the year! September is the gateway to the football finals; the cricketers are emerging from their chrysalides; and the festival finishes on the first Tuesday in November. A September 1 Australia Day would be a time of rebirth and not one stained by the metaphors surrounding colonisation and invasion.

Leave January 26 to New South Wales to work through those first years of the Rum Rebellion – and with climate change the temperature will probably be the same in September as it is now in January.

The Doctors’ Dilemma

In 1946 the Australian Constitution was amended to include the provision of health benefits for medical treatment, dental treatment, hospital and pharmaceutical benefits. Very specifically defined. In 1946 when this question was asked of the people of Australia, there was not the diversity of health professionals operating outside an institutional framework.

Therefore whenever any other professional group (apart from the dentists) wants access to Medicare, they have been blocked by the Constitution. Except that there have been a number of instances where the Constitution has been sidestepped, notably in the 1970s when optometrist benefits were introduced. It so happened that at that time there were a number of optometrists who were politicians on both sides of the House – and bingo, benefits were introduced because optometrists in the provision of these services were deemed “medical”.

In fact, many areas of medicine could not operate without the inclusion of the cost of the nurses, technicians and scientists, as occurs in pathology, radiotherapy and diagnostic imaging. The fee for Medicare benefit can incorporate a professional component (the doctor moiety) the technical moiety (including the non-medical staff) and a capital component (for the machinery). This is best exemplified in the structure of radiotherapy benefits.

However with the expansion of the Medicare Benefits Schedule after 2000, payments were made to a whole variety of health professionals through the Medicare Benefits Schedule but all were contained within or linked to medical care.

This interplay with doctors is shown by the midwife eligibility criteria:

A collaborative arrangement is an arrangement between an eligible midwife and a specified medical practitioner that must provide for:

(a)  consultation with an obstetric specified medical practitioner;

(b)  referral of a patient to a specified medical practitioner; and

(c)  transfer of the patient’s care to an obstetric specified medical practitioner, as clinically relevant to ensure safe, high quality maternity care.

There is no independent set of benefits. “Collaborative” is the closest the government legal advice has allowed given that “deeming” would be a red rag to the bull for the present generation.

However, this cute sidestepping trying to avoid the Constitutional restrictions only survives unless there is a High Court challenge.

Currently this manoeuvring does not threaten the doctor’s livelihood, but once the threat of another health professional group threatening general practice incomes then it is not only the politicians who will hit the fan.

Obviously if your basic income is government guaranteed who would not want that? The AMA is reported as being opposed to nurse practitioners obtaining Medicare benefits for their patients as with the independent stream of allied health professionals. If the government were to do so, would nursing be deemed “medical” or would the Government have to put nursing benefits as a Constitutional amendment to a referendum? With the backing of powerful nursing unions in an atmosphere ignited by the MeToo movement, any referendum would be a forgone conclusion.

Getting an amendment into the Constitution would be one achievement; it would then be a case of setting the scale of benefits. All the arguments about relativity would explode both between professions and within the nursing profession and each of the other professions included in the Constitutional amendment.

Talk about Pandora’s Box. In amongst this mayhem the central agency boffins would be tearing their hair out over the fiscal consequences of all this.

And compounding all this political noise is the proposal put forward by Shorten to set up a universal dental scheme – I shall deal with that in my next blog. Ah, the joys of policy formulation.

Mouse Whisper

The owner of the Dry Dock pub on the Finke River was heard to say to the customer in white:

“Son, when are six feet eighteen hands? Not too difficult to fathom the answer.”

Modest Expectations V

The Roman V for five reminded me of this anecdote which some may find trivial and others may see as something more profound.

It was the time when Vic Garland, the then Opposition whip, was giving the second reading speech in reply to the legislation on the Australia Council Bill. Bill Snedden, then the Leader of the Opposition, was to have given the speech but his wife’s unexpected illness precipitated his early departure from the House that day.

It was an impressive speech, and Vic Garland had an equally convincing delivery. However, there are always pitfalls when the speaker, no matter how impressive his diction, has a basic unfamiliarity with the topic. In referencing the costly purchases of Jackson Pollock’s “Blue Poles” and of de Kooning’s “Woman V”, he said “Vee” instead of five. In Hansard it stays correct, and a mispronunciation was a zephyr wisp drifting across a somnolent chamber. Like Vic Garland, a zephyr comes from the West.

Perhaps Vic would have been somewhat surprised that the speech had been written by Jack Hibberd, the playwright of “Dimboola”, and John Timlin, who was the administrator of the Melbourne based anarchic Australian Performing Group with their outlet the Pram Factory in Carlton. Snedden had read the speech and given it the “thumbs up”. He did not care how either of them had voted. He just agreed with the sentiments in the speech.

Vic might also have been somewhat surprised had he known who the authors were. The words that Vic uttered inter alia may have been seen to be somewhat radical:

I have pointed out that less than 5 per cent of ACA funds have been directed to community arts by the Whitlam Government – a so-called populist crew which rows its fiscal boat to the already well-endowed shores of those few cultural monoliths who have for years fed well on the subsidy cake.

And further on: “To spread available funds widely through the community seems now to be a shared aim of both the Government and the Opposition. A basic requisite then is close consultation with the State directors since these are the people closest in touch with regional local groups. We reject totally the notion that the Council should consist of itinerant and possibly ignorant friends of whatever government happens to be in power.

All parties want our culture preserved and developed. We wish to see diversity of the culture maintained. We wish to see Aboriginal cultural efforts expanded without destroying the intrinsic requirements and tenets of that culture.”

 Vic had delivered it well apart from the “Vee”. Hibberd and Timlin, watching on, may have shuddered but in the long term what did it matter? In any event, a month later, Snedden was gone.

Trying to establish policy where the aim is to seek views from all sides of the political spectrum is a tough task, and you lay yourself open to yon Cassius. After all, being the centre should be purple – the place where blue and red mix.

I remember well the judgment by the Coalition backbencher of the Snedden staffer who was seen talking to the young Charlie Perkins around a campfire outside Parliament. “Who is that bloody communist working for Snedden?” Talking to Charlie Perkins. Shock … horror.

Trolls always have difficulty with the concept that my adversary may only be as close as my policy neighbour. Their angst, alienation and ethnic hatred is a bar to anything.

Later Snedden would be a good friend of the Pram Factory in assisting its survival. He was very loyal.

The Triennial Comedy Festival

It is strange that when there is a national election, I always think what would it be like if Australia were a Republic. I am a republican, and have been since I was very young. Even though I had a privileged Anglican education, it was always my Irish roots that called me to the Republican cause. I was comforted by the fact that the early great Irish revolutionaries like Robert Emmet and Wolf Tone were Church of Ireland and not Roman Catholic.

I may say I am “committed” but I never joined the Turnbull caravan nor the current Red Bandana Brigade. One reason is that with Elizabeth on the British throne, it is an exercise in futility.

For no reason other than most of the population have known no other monarch and she is such a closed, controlled individual – a metaphor for a colonial lounge room, comfortable, cream coloured walls with flashes of colour in the curtains. The flashes of colour signal how good the British Royals are at pomp. However at the same time, monarchy is a symbol of nostalgic stagnation glossed over as “certainty” – and who expects her to die?

Yet there is a second reason for going easy on my republican stance and that is the Australian election cycle.

The current Australian election campaigns are run as if they are Presidential, but only in style. Presidential substance, however, comes against constitutional barriers, which are impossible to avoid.

We have to ride the carousel every three years to elect a new government. The community finds it hard to keep up the interest at the best of times when elections are so frequent, hence the media attention on the bizarre array of peripheral political buskers.

However, if we removed all the trappings of a foreign monarchy, most politicians would be comfortable with a system where the end point would be “me” as President. Australians would now have a flexible “Republican” constitution, the Presidential hand would be on patronage, the bizarre fringe would be in the government or in an asylum depending on Presidential whim, and I nearly forgot: “pesky” elections would be held once every ten years.

Currently the autocratic President is the fashionable model, a person who alters the constitution to remain in power with a series of coercive institutions to maintain that power. Trump yearns for this power; democracy is a hindrance. When one looks back on the Trump legacy, the end point will have led to the destruction of trust and paralysis in rational policy formation. Government decision-making becomes a game of dice for the rent seekers and mercantilists.

Now if we got rid of Elizabeth, then elections could become real American vaudeville. Roll up, roll up and see the Screaming Circus Strong Man. We sober people are shocked; we avert our eyes from this grease-painted figure.

However, this behaviour does not seem to affect his following any more than stage performers shed their audience. That is a republic!

Trump has an audience. It is only that Trump has an unusual spiel for a politician – he insults and his audience squeal with delight. It is a well known trick of the comic. However, remember, beware the mob that in the end invariably pulls down the figure that it has created.

Maybe our election campaigns freed from our Constitution would become festivals of the absurd – after all, the Italians have Beppe Grillo, a comic who is the eminence grise of the Five Star Movement in Italy; the Ukrainians have just elected a comic, Volodymyr Zelenskiy, as President for the next five years.

Of course nothing like this would happen in Australia, proclaimed the Best Country in the World. Our politicians are serious people. They are not comics; desist, you with your hand on the voting paper, desist from saying anything. Let us not have cheap irony; and anyway the “word” is comical.

So let the republican idea lie for the present.

In three years time when this campaign is all repeated and when the climate is teetering on the edge of the irreversible, when rent seekers and short-term carpet baggers seem to have retained their ascendency, it is only a hope that the electorate as a whole will have at last awakened – listening to the sounds of our descendants, pawns sizzling on the barbecue of climate change. Hopefully Australia would have stopped drawing the Joker from the pack of policy options!

Then in six years, there will be only two words on the election campaign trail – “Water” and “Climate “. Nevertheless, all may not have changed. Hannah Gadsby may be leading the new Social Democrats. Then we can think of a Republic – when it is a necessity.

A magnificent obsession

Tim Fischer is a great Australian. When he looks at you, you feel as though he is peeling away the layers of crap that you pick up in a lifetime of being in the System and seeing whether there is something underneath. He speaks in his own unique argot, but he does not need a translator. You know perfectly well what he is about.

Sir John Monash

One of his obsessions over at least the past decade is Sir John Monash posthumously being raised to the rank of Field Marshal. Many have attributed this not happening in his lifetime to the fact that he was Jewish at a time when being Jewish excluded you from such institutions as the Melbourne Club and when the Roman Catholic Good Friday liturgy made mention of “perfidious Jews”. In fact Monash had been sent to Scotch College over Melbourne Grammar School because Scotch taught Hebrew.

Another reason was that Monash was “militia” and not “regular army”. After all, “the traditional” Haig insisted on sending the cavalry in to the last stages of the War, notwithstanding that Monash the engineer, because of his technical superiority, had virtually won the War already.

Monash was loved by his troops; to him one Australian casualty was one too many – and in the final offensive which defeated the German army, some of the feats performed by Australian soldiers were extraordinary – frighteningly murderous to Germans in their own way but building upon the stuff of the Australian legend.

I know that Tim Fischer wanted to see the posthumous award of Field Marshal in 2018. He asked Turnbull and Turnbull, as was his wont, deferred the request to the armed forces hierarchy. They said no; Turnbull said “no”.

Fortunately, Bill Shorten was a proponent of recognising Monash. All the obfuscation about not doing so is at the feet of academics and of course Brendan Nelson. Chattering about precedent, one hears the voices: “You know, he never commanded enough men to be a field-marshal; he was only a lieutenant general at the outset of the final campaign” – and on it goes.

The Digger, emerging from the shadows of war, can be heard saying: Mate, he won the War. Don’t give me this stuff about a posthumous award being a dangerous precedent for others to be promoted after they have died. There was only one Monash.

And by the way, there is only one Tim Fischer.

Mouse Whisper

“No matter how rational, logical and ingenious Monash was, there was nowhere to escape the insanity of war. “

Roland Perry the author of these words is a remarkable wordsmith – first published in 1979; 7th book 1994; 17th book 2007; 28th book 2014.

Modest Expectations Fore

Golf puzzles me. However, I do enjoy fluttering around the Masters Golf Course in Augusta on the YouTube bird. A floral pilgrim arboretum with quaint names like Amen Corner and Flowering Crab apple; kaolin coloured bunkers; water courses and ponds interwoven with trees and bushes which seemed to be groomed rather than planted. The spring flowering dogwood, azaleas and magnolias provide a regimented colouration – red, pink yellow and white. The annual Master’s tournament is testimony to that Brownian movement which is America. The winner this year – an epithet for Trumpian America – tiger woods.

In contrast, every time I pass the Rosebery golf course on the West coast of Tasmania, against the mountainside away from the local zinc mine there are abundant green fairways dotted with a mixture of exotic and native trees – just varieties of green. Perfectly groomed but lacking bunkers. Never have I seen anybody playing golf there – not even a Tasmanian devil stirring – it seems a golfing Marie Celeste -an epithet for Canberra at election time.

Lessons from the Memorial Sloan-Kettering Malfeasance

The whole political spectrum is awash with promises of funding for cancer but it is nigh impossible to predict the expected outcome from the actual outcome. The ALP seems to want to provide money for patients whereas the commitment on the Coalition side seems to favour research.

Except for certain localised cancers, mainly of the skin, the cancer patient become a statistic in the survival rate – in other words the cancer patient always hopes to be at the far end of the survival curve. Increased research funding is equated to increased survival.

The current Australian election campaign is awash with promises to tackle cancer. The time-honoured political response is to promise more money for research – however it is dressed up. Politicians have always seen cancer funding as a vote winner – they can provide funding without strings and bask in the immediate kudos.

Therefore, the recent Memorial Sloan Kettering Institute disclosure is something to make everyone pause. This institute is prestigious, shorthand for “above reproach”. I have actually visited this sprawling but unremarkable bastion of cancer treatment and research on the East Side of Manhattan.

The New York Times has been progressively reporting what one may describe as “malfeasance” – corruption seeping through the upper echelons of the Institute.

The heart of the matter as reported by the NYT is that fact that “scrutiny of researchers’ stakes in start-ups has intensified at a time when venture capitalists are betting millions of dollars on the next potential cure for cancer and when expensive treatments like immunotherapy have fueled public concern over rising drug prices.”

As reported in the NYT, a review, conducted by the law firm Debevoise & Plimpton presented a week or so ago concluded: “that officials frequently violated or skirted their own policies; that hospital leaders’ ties to companies were likely considered on an ad hoc basis rather than through rigorous vetting; and that researchers were often unaware that some senior executives had financial stakes in the outcomes of their studies”.

There has been a great amount of public soul searching, but it seems that despite the list of questionable activities at the Institute most if not all those with fingers in pie have survived and the cosmetic changes and promises to do better have not been matched by deeds. The excuse is that culture change takes time, but when the direction of research becomes a branch of a hedge fund, then in the long term the effect is that of a “warm lettuce leaf” sanction.

However, when the scandal emerges in a leading institution in USA, it is reasonable to assume it is not an isolated example. The problem is that anything to do with health is now a business and health is just one commodity on the sprawling profit and loss sheet. Aiming to save lives in the most effective manner – an incidental – is met with guffaws by this coterie. So let the policy makers shed the faux Pollyanna approach to research funding, knowing how difficult it is to remove emotion from any decisions – hence this is an area where any policy makers worth their salt should follow the money trail – and hopefully not end up finding a Memorial Sloane Kettering Institute at the end of the trail.

Howard Florey, our greatest Australian, the man who gave penicillin to the world would have shaken his head in disbelief. He never benefited from the discovery; never made a buck out of a drug which saved millions of lives but ironically changed the fortunes of the pharmaceutical companies who picked up the patent.

After all, infectious diseases were the cancer equivalent of the day. Lest we forget. 

The Out-of-Pocket Expenses

Cancer is multifactorial; it is an expression of everyone’s mortality.

We, the patients have to bear the brunt; and given the mortality surrounding cancer that brunt is so often deadly.

Pancreatic cancer in particular has a five-year survival rate of 7-8 per cent; and that is survival not quality of life.

Some unfortunate people get multiple cancers – just not metastatic spread. Many cancers are terminal. Treatment is surgical, radiation, or chemotherapy – cut, irradiate, poison. There is nothing pleasant about cancer; and if you emerge from this experience and are presented with a huge bill then it adds to the unpleasantness.

One approach to alleviating the burden of cancer is to improve the funding of the actual care, and that seems to be at the heart of Shorten’s stance. Minimise or eliminate the out-of-pocket expenses. However, apart from waving a few figures around, the implementation is just that – short on detail.

There are number of matters which need to be balanced – the Medicare benefit the government is prepared to pay and the fee the doctors charge. The figure of $150 has been mentioned as some extra payment. What does that mean?

Inevitably as one grows older, one is faced with the prospect of surgery. As a privately insured patient, I always ask what will the whole business arrangement known as “operation” cost.

What is the price? How much will that vary from (a) the MBS benefit (b) the amount guaranteed by my level of health insurance? The surgeon is responsible for the whole episode including post-operative management no matter to whom he or she may delegate it.

There is the anaesthetist – the person who suddenly appears before the operation at the behest of the surgeon. Since the surgeon hires the anaesthetist, it is reasonable for his or her price to be disclosed.

Then there is the surgical assistant – often a supernumerary – but who has to be costed in and someone the patient probably never sees. “Is that person necessary?” is the obvious question.

The same occurs with pathology – the pathologist is rarely seen – and diagnostic imaging, where the patient may see somebody vaguely resembling a radiologist.

Then there is always the matter of complications to be factored in and therefore the total cost before anything else needs to be agreed. The patient should not have to bear all the risks.

Similarly there needs to be a price put on the radiotherapy or chemotherapy, with may occur in association with surgery or independently.

Then there is the unknown – the cost of palliative care. Unless, you the patient are demonstratively terminal, it is not something the average cancer patient wants to think about. But nevertheless it entails a price; dying from cancer is not cheap.

When you buy a house, you don’t buy it room by room. Therefore, for that purchase knowing what you do, what your entitlements are and then negotiating from a solid basis breeds a degree of certainty. If you as the buyer feel this task is all too daunting you get someone you trust with the appropriate knowledge to do it for you.

Buying a property and assuring health are no different in needing a broker than any other commodity.

Now try and translate that into what the political parties are suggesting as health policy. This area is complicated by the current review of the Medicare Benefits Schedule, which has been going along for four years but with an end point in creating a new MBS schedule without putting any value on any of the items. Alice may well be asking where is the tea party.

Yet the ALP has a proposal putting finite values on patient reimbursements and injecting them into health care financing. Pluck a figure from the policy teapot to give to the patient as an added benefit, and the market may absorb that benefit and the price for the service commensurately rises.

The current state of affairs is not the best situation in which this policy initiative is being put forward – private insurers put up their premiums, doctors charge what they believe their services are worth or what they think the market will bear, the central agencies of government hover to squeeze the value of the benefits.

Let us set out a premise. Once diagnosed, cancer treatment in our affluent society should be cost free to all. Having made this statement it is tempting to think that premise too fanciful. However that is the challenge and just throwing a consultation benefit or subsidising one piece of equipment to the exclusion of others does nothing to solve the problem.

It would be useful if the patient could choose a one-year or five year survival package with named participating doctors, health facilities and health insurers who would accept the package based on the mean expected survival. The actual projected expectations should balance out the assumptions underpinning the package. The assumptions should be made clear. Work on the basis that whatever figure, however fair and reasonable will be inevitably wrong; so err on the side of generosity.

This is not fanciful – there are arrangements where surgeons label them selves as “no gap” when linked to particular hospitals with arrangements with health insurance, but it is patchwork – sometimes quite attractive patchwork.

However, it does not absolve government, and when politicians enter funding for cancer, there should be a plan to give the cancer sufferer a non-transferable amount of funding either in a one or five year package according to the expected price of such service – realising that currently MBS benefits provide a de facto floor price – the public hospital provides a guaranteed government funded place. Private hospital insurance premiums and the AMA list of recommended fees provide the other end of the price spectrum. Work between those two limits and determine the fund holder. In the end if information were symmetrical it should be the patient and his or her family, however defined.

The resultant cost accounting exercise should not be beyond the wit of a smart bureaucracy. Absolve oneself from the clutches of the external consultants to do the work. Have a team dedicated to the task – not as happens all the time continually shift the bureaucrats around to destroy any continuity and thus disrupt the timetable.

Do not let the work of this well-intentioned attack on cancer meander for years. Have a very concise timetable – three to six months. There is enough information. It is a matter of distilling the options. Go to it.

Mouse Whisper

Overheard on Big Rat Island:

“Whose idea was it to change the Island’s name? Totally inappropriate! Kerr was not big.”

“But you forget the top hat, mate.”

Modest Expectations Hiru

“This is a serious horse, Mary Lou!”

These slightly reproachful words were uttered by a Spanish dressage instructor on a property west of Theodore in Queensland, where he was conducting a dressage training weekend. The owner had dared to turn away from watching him put her elegant black horse through its paces to chat to her friend. She should have been closely watching the intricacies of what the rider was doing, hence the sharpness of the tone. I was just an onlooker, but these words have entered my lexicon as words when you want to concentrate the mind.

I have followed Winx since her first win as a two year old in 2014. She has grown in stature since that time – a serious horse in every meaning of the word.

As she faces her last race, I note that the Liberal party are having difficulty pre-selecting candidates in some seats.

Just a silly thought to believe that you could put Winx on any of those ballot papers, now when politicians are so much on the nose. I would wager she would get more than just the “donkey” vote.

After all, the Emperor Caligula made his horse a consul. And they thought he was mad. However, I believe that horse won his election in a canter.

(Painting of Bowman and Winx by Garry Higgin)

The Protoplasm that is Politics

The Coalition Government in 1972 was a remarkable beast. It was caught up in Menzian aspic in a culture of internecine strife, which had been plated during the Holt days as Prime Minister. While John McEwen was around, this protoplasmic mess was controllable. However, he retired in 1971, and McMahon was let loose.

At the apogee of Australian civilisation as we knew it then was Prime Minister William McMahon, a prissy spiteful destabiliser, whose contest with the truth was in most cases found wanting. He had married late in life, and used his wife as a fashion plate accessory – remind one of someone? His government had difficulty in disentangling itself from the Vietnam War – and remember China was then indeed the Yellow Peril – a place for Australians to be quarantined against. Policy considerations were neglected by a Government exercised by whim and patronage spiced with payback.

Gough Whitlam by contrast provided an articulate alternative, offering Australia a new way. His election campaign was vigorous and enthusiastic. He had vanquished the Old Guard and promised so much – his clarion call being “It’s Time.”

Yet even with support of Rupert Murdoch, Whitlam ended up with a majority of only nine seats – and five of the ALP gains were in NSW.

Morrison – compared to McMahon? Time will tell. The Liberal party in 1972 had the DLP albatross, but now the continuing DLP cohort is embedded in the Falangist arm of the Liberal party. The Liberal party branches, once conceived to provide policy advice – “listening to the people mythology” – in reality are the vehicle for partisan pre-selection. It is thus unsurprising the so-called Liberal party has the crop of politicians it now has, seemingly out-of-step with the electorate.

That seemed so true in Victoria; but does it matter what candidates you have when one ignores the yearning for centrist politics where the art of negotiation is preferred to the strident megaphone?

In Victoria at last year’s State election, Daniel Andrews achieved an electoral landslide. In NSW Gladys Berejiklian has held the line for the Liberal party. Each has been pouring money into infrastructure, in a way that Whitlam promised to do in 1972 – into cities, regional centres, health and education. You can imagine Andrews and Berejiklian preferring the first way rather than yelling at one another, especially now they have both been re-elected for four years.

Morrison clings on, his hand on the megaphone. He should look at the 1972 and get some comfort, where in the end the overall swing was 2.5 per cent and even with McMahon, the Liberal Party still won four seats from the Labor party. At that time there were three Liberal and one National party premiers, including NSW, Victoria and Queensland. Today there are three Liberal party premiers in NSW, South Australia and Tasmania.

And Shorten is no Whitlam. He does not have the charisma. Unlike Whitlam, he has two strong lieutenants, Wong and Plibersek who, as the election nears, may become more prominent. However, with the media concentration on the two leaders, because the imagery of the prize fight is much more easy to convey in an election, emphasise the ‘may’. Therefore with all the talk about gender equality will these powerful women resonate – or be allowed to do so – in rural and regional Australia.

Even if the players are different, the scenario is reminiscent of 1972.

The long term lesson for what should follow as could have occurred from 1973 onwards? Defining and constructing the hard centre of politics, combatting this tiresome fearmongering, remembering what David Owen, the British politician, once said to me – never get caught in the soggy centre of politics. One might say that his is a re-interpretation of that familiar mantra – drain the swamp.

But that is only the start … hard… please define!

A few thoughts on the first salvos in health policy – Chris Brook comments

The budget and budget reply 2019 are now completed and no one could mistake that each was effectively a campaign launch for a Federal election – ending up as six weeks after the Budget.

Both have committed to expansion of funding for MRI and imaging more generally, (well done whoever lobbied this through both parties because there has been longstanding underinvestment in this technology). However, the ALP proposes to invest in greatly reducing out of pocket costs for cancer care, most of which is non-inpatient.

It seems ironic that the ALP is prepared to pay to repair a problem that is partly due to withdrawal by States of public oncology clinics. Thus, patients cannot access free care. The end result of the ALP’s plan hopefully will restore free care in public hospitals. It will be interesting to see if the Commonwealth chooses to claw back funding from the States for this, in effect exacting a punishment.

The Coalition has committed $450 million on chronic disease payments, especially for diabetes. Missing so far is the detail of what is new funding as opposed to just altering MBS descriptors.

The literature suggests such programs improve patient perception of care, which is a positive, but neither reduce cost nor hospitalisation rates.

Mental health funding is boosted in the Budget, though spending more on Headspace where its evaluation has given at best tepid endorsement. Nevertheless, any money directed to early psychosis is welcome.

Both sides promote their resumption of indexation for GP attendances, and not before time. It was always a cruel means to cut outlays.

The Coalition commitment to fund new drugs is welcome, though I note that the cost of the PBS is rapidly becoming the major cost driver in health , approaching $14 billion per annum. However, since “Big Pharma” makes a number of concessions and discounts from the list price, the real cost is closer to $9bn.

The rest is snippets and bits although the absolutely uninspired changes to Aged Care and Disability will have a strong indirect impact. If patients cannot access care, the putative expansion of care lends an air of unreality. By default the aged and infirm are forced to attend local general practitioner clinics or hospital emergency departments.

From my objective standpoint, the ALP wins this round, but it is early days in the campaign, so keep alert for further comment.

Mouse Whisper

Heard in the back of the Melbourne Club Caboose: “These three blokes born in December were given a portrait of Winx, each with Hugh Bowman atop. Why? Because a Sagittarius is half horse, half bowman.”