Modest Expectations – The Two Noble Kinsmen

Leigh Sales, what planet are you on? Take your statement last week about those poor tradies who need to drive Uber at the weekend for extra cash. It was put into perspective a few nights later when – that “uber tradesman” Scott Cam was revealing as “chiselling” the Government out of a six-figure sum for his part time services. For his part-time activity he was not behind a steering wheel. He is the Wheel!

Ms Sales, “tradies” as you call them are doing very well, by and large. Probably given you are upwardly mobile, it is just conceivable that you employ a “tradie” or two. I like the word “tradie”; it fits into all forms of the alphabet a-gender

From personal experience, one of my “tradies” owns a hotel and the other has so much work, the last thing he requires is the wheel of car in the evening other than to go home. I suggest that Ms Sales profiles the Uber driver. I know anecdotally my Turkish-born taxi driver who has been driving me for years and who has had a network of drivers from the pre-Uber days, now drives for Uber in addition to his own clientele. However, I suspect that you will find a great many Uber drivers, who are first generation arrivals in this country.

One of the interesting aspects of taxi travel, of which I once did a great deal, always riding in the front seat, I learnt a lot about the outside world; it was the front seat to an ethnic collation.

However, the racial profile of taxi drivers has changed. I always remember a young Greek doctor who, when he first arrived in Melbourne in the mid 90s, could not believe the number of Greek taxi drivers here. Now there are less Greeks. Taxi driving is an indicator of a less established community. For instance, you may find that an increasing number of Sikhs, newly displaced from the Punjab, are a major taxi or Uber population. But freed from the bureaucratic entanglement of the old taxi cartel, Uber driving attracts the retrenched older person and the student out to make a quid – particularly overseas students. I do not deny that there is a poor postilion under-class, but it ain’t “tradies”.

Nevertheless, it made me think about the proposition of the under-utilised “tradie” workforce, if indeed there is such a thing.

Given that it is a local council responsibility to provide a home maintenance and modification service in addition to hospital adjustment to daily living (ADL) for patients returning home, I would have thought that if there were these Sales’ “tradies” out there looking for twilight cash, then they should be easily absorbed more usefully into an Australia-wide home maintenance and modification service co-ordinated as it is locally. It is difficult to gauge how prevalent these schemes are; I remember when I was running a community health program nearly 40 years ago, some of the more progressive local governments had begun to set them up, but in those days there was a bureaucratic separation between health and housing.

Michael Portillo has recently fronted a documentary on the UK public housing situation acting unfortunately as an apologist for (rather than he once was an acolyte of) Margaret Thatcher. She was guilty of poor decision making when she sold off the social housing stock for a pittance without any strategy for its replacement. Portillo himself tried to absolve her of the social vandalism.

The whole question remains of who pays for social housing but more importantly prevents the purchase for its speculative purchase to drive up prices and hence to conceal the underlying inflation in the economy. At the same time the tacit pact between big business and government suppresses the earning power of those who should be able to afford such housing, either by renting or purchase.

In any event, it is just another area for you to explore, Ms Sales, especially with all this talkfest going about us aged across Australia, rather than indulge in the mythology of the “poor tradie”.

Albanese and the Coal Scuttle

The Adani Coal Mine is a private mine. It’s been approved. It is going ahead. It’s not a Government mine… Finance has been the issue with the Adani mine, but it’s had its environmental approvals. I support the jobs that will be created by any project, any project in Queensland or anywhere else for that matter. What Government needs to do is to set in place strict environmental guidelines. When those guidelines are approved, then you have projects which go ahead if they receive private sector support. 

The first reaction to this Albanese mouthing is that the weasel should be removed as a protected species irrespective of the Albanese predilection to cuddle the animal.

Let us make an early prediction. Albo will have difficulty retaining his seat if he does not do a better job of explaining whether he will be emulating the Prime Minister and going into the House brandishing a lump of coal – Balmain coal – or not. After all, his electorate boasted a coalmine, and my late neighbour remembered as a boy running around the corner to pick up some lumps of coal for the family stove. The air was full of coal dust, pit ponies were still being lowered every day into the mine and there were several major accidents when men were killed. However, the coal was convenient to keep the stove going and the fire alight; ensuring the skies were grey.

It is written in the wind as far as you are concerned Mr Albanese. Go on a trip to Queensland, hug a replica of the Balcaldine tree, and desert a Sydney where the pall of brown smoke foreshadows summers of the future, where blue skies are an increasingly distant memory, as they were when coal was mined.

I have lived in the electorate long enough (although we were only recently redistributed to Albo) – long enough to have seen it desert its working class legacy to that of wall to wall cafés. I can remember the whistle signalling that work had commenced on Cockatoo Island across the Parramatta River. I can remember the odours from the soap factories, which had saponified the river for years. I had walked up the hill and been shown the entry to the Birthday and Jubilee mine shafts that had been sunk when Queen Victoria was in her venerable years. The area was a wasteland of weeds, but you could still see the access points to the mineshafts. The soil is thin and poor in Balmain and as you stir it you wonder how much of the contamination of the past is floating into the atmosphere. And the working class had to endure it, while the tycoons flourished.

Balmain coal mine

In Balmain, one of Paul Keating’s achievements in decontamination was the development of the old Ballast Point Caltex site into a magnificent public park; so much of the harbour waterfront was lined by industrial sites, now gradually renovated, although not necessarily reflected in the growth of liveable space. The working class has become educated, but the same tycoon-types still exist, now complicit with a rising rent seeker class, a.k.a. politicians.

Now, Albanese of Grayndler goes off to circulate in central Queensland, unfamiliar territory for a Sydneysider well versed in the rent seeker class who inhabit Sussex Street but will the Camperdown boy be seen at the end of the street in Moranbah? How much can a fleeting visit do for the Queenslander’s view of you, a Mexican arrayed in RM Williams clobber, your sombrero at a rakish angle to display your winning countenance.

Then that statement you made of: “if we don’t mine it, somebody else will.” A variant of “if we don’t kill our grandchildren than somebody else will”. How well you demonstrate the Hollow Man.

When you come back to your ex- coal mining electorate of Sydney, I’m sure you’ll get a rapturous welcome with us all waving soot laden miner’s lamps to welcome your return.

Oh, by the way, when you are hob-nobbing with the Adanis, tell them we exported coal from Sydney to India in 1799. It will inform how important your electorate has been in defining the genesis of Coal as an invaluable Export -and you as a reaper in the Carbon field, its representative.

Anti-Vaxxer – Prosecute for Genocide Part 2

According to a 2018 report by Complementary Medicines Australia, the country’s complementary medicines industry made $4.9b in revenue last year — including $2.77b in vitamin and dietary supplements — and is expected to grow by another $2b over the next five years.

Just a casual comment to indicate how much porcaria Australians are pouring into their bodies every year. What I find disgusting are the advertisements which show the happy family images loading up their shopping baskets with this stuff – as though a healthy young family needs it – and some of these naturopathic fanatics have the hide to fill their children up with these drugs while at the time perniciously undermining of the community’s health status, trying to claim that vaccination is harmful. Anti-vaxxers have been allowed to roam in this community.

We should take a leaf out of the Samoan legislative book, and prosecute and jail those who would willfully promote ant-vaccination messages and promote rubbish substitutes. To kick this matter along a letter will be sent to each politician in Australia, asking the simple question of whether they support vaccination or not. It will made very clear that a non-response will be taken as a “no”; and the results will then be published, so that at the next elections these enemies of the welfare of our children can be identified and dealt with at the ballot box – at least in the first instance. Legislation will follow.

Telling it how it is

Below is a note received from my private health fund. It is clear and needs to be read against the outpourings of the Grattan Institute.

I read the comment of one journalist the other day, who describes herself as “senior”. She reckons that she does not need all that private health insurance stuff – you know cataract, hip surgery and that unfamiliar set of lesions called “grab bag”. She boasts that she is fit and into marathon running. The association between long-distance running and knee and hip injury is still in dispute.

The problem is that the attitude being promoted by such comments constitutes an attack on community rating. Once community rating is destroyed, then life is a lottery as you enter the realms of catastrophic insurance and you being rated on your individual profile. You are laid bare – no community rating to protect you; warts and all, literally.

The other factor, which has had a disastrous effect on the health system, are all the cost shifting antics of the States, to which the health fund attests below. And even more outrageous, the diversion of money destined under the Commonwealth-State funding agreements being diverted to uses other than the health portfolio.

Anyway, in the meantime, read what is said by a health fund, which is not set up to make obscene profits to be repatriated offshore, but one where the membership is put first. Surprising, you say, but it does occur.

It can be a distressing time when you are admitted to a public hospital emergency department due to an accident or unexpected illness. 

Together with seeking medical care, you will be faced with another decision – do I use my private health insurance policy or Medicare to cover my admission?

What does it mean to be a private patient in a public hospital? 

To be privately covered in a public hospital means your private health insurance policy with us is covering your admission, rather than Medicare.  The admission costs can include your accommodation, theatre and medical fees. 

There are genuine and appropriate reasons to receive treatment as a private patient in a public hospital. However, its increasing prevalence in recent years has raised concern around the reliance of public hospital funding on private health insurance, and the impact this is having on premiums.

You may be approached by administrative hospital staff. Roles have developed within public hospitals and these staff, called patient or client liaisons, are responsible for signing up private patient’s health funds. There has been recent criticism made of the tactics used by these staff, so it is important you have the facts to make your own choice if you are approached: 

There is no obligation to use your private health insurance 

If you are eligible for Medicare benefits, you can choose to be covered as a public patient and all medically necessary inpatient costs will be covered by Medicare. You have a right to be a public patient, even if you have private health insurance, and this should not affect the level of clinical care you receive. 

The hospital may offer additional ‘perks’ if you choose to be a private patient.

Public hospitals are known to offer additional benefits to patients who choose to use their private health insurance, including free Wi-Fi, food vouchers or parking discounts. Information about being a private patient in a public hospital can be hard to find and varies between hospitals; particularly in regards to more important benefits such as guaranteeing choice of doctor, access to single rooms and specialised follow-up care. It is important to ensure you are receiving the right benefits by using your private health insurance. 

You could have out-of-pocket costs if you use your private health insurance. Your policy with us will apply to your admission if you choose to be a private patient in a public hospital. This means, you may be required to pay any excess, and the doctor who treats you may charge a gap for their services, above what Medicare and the health fund will cover. It is important to remember that if you are covered by our basic policy, no matter how it is promoted, any exclusions or restrictions of your policy will apply, so you may not be covered for the services you require.

Using your private health insurance can affect premiums. It has been reported that growth in private patient admissions in public hospitals has contributed to approximately 0.5% per annum increase to premiums over the past five years. This means, private health insurance premiums can be contributing to services that could be receiving public funding paid through taxes.

It is important to remember you have a choice when deciding how you will be covered for services in any private or public hospital.  

Be informed, be equipped with the right questions, and know your rights as a patient.

Amen.

Mouse Whisper

Some years ago, when Aleppo was still a beautiful place, an Australian senator was reported in The Weekend Australian as saying

“Syria is a country that has been a bastard state for nearly forty years.” However it should have read: “Syria has been a Baathist state for nearly forty years. The Australian regrets any embarrassment caused by the error.”

Sadly, no need to correct the statement these days.

Souk of Aleppo

Modest Expectations – Qin Shi Huang

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

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

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

An Apologia of Academics

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

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

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

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

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

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

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

Impartiality – the silent partner in Democracy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Media & Private Health Insurance 

Guest blogger:  Terry Stubberfield FRACP*

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

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

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

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

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

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

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

So medical services are just one piece of the puzzle.

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

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

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

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

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

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

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

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

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

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

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

A Royal Wave through a Crack in the Door

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

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

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

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

However that is trivialising the seriousness of the claim.

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

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

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

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

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

Broken is the crown …

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

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

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

Mouse Whisper

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

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

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

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

Modest Expectations – The Spine

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

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

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

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

“Unfair question. Impossible to know.”

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

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

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

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

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

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

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

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

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

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

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

The Senile Trail

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

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

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

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

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

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

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

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

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

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

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

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

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

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

* Modest Expectations – Duckworth 30/8/19

Mount Augustus

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

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

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

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

Burringurrah / Mount Augustus

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

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

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

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

Burringurrah speedway

Sydney Ferries Fiasco – A form of naval gazing

Guest Blogger: Neil Baird#

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We have not heard the end of this.

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

Mouse Whisper

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

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

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

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

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