John Menadue

  • John Menadue. Postcards from Hanoi.

    I will be in Hanoi from February 17-26, attending a Hoc Mai Foundation workshop on learning from each other about health issues in Vietnam and Australia, and assisting in the learning of English in the health field. Hoc Mai means ‘forever learning’.

    The foundation was established in the late 1990s. University of Sydney was a very active partner.  Over 30 groups of Australian clinicians and others interested in Vietnam have travelled to Vietnam since the late 1990s. 29 Australians will be in our group in Hanoi.

    Emeritus Professor Kerry Goulston will be leading our group. He has made almost 30 visits to Vietnam as part of the Hoc Mai Foundation.

    During this February visit, a few of us will be sending ‘postcards’ from Hanoi. The first postcard  from Jonathan Page, a medical oncologist, follows.

  • Robert Manne. Why we have failed to address climate change.

    In this article, published in the December The Monthly Essays, Robert Manne describes the major obstacles to addressing climate change. He refers to the unique nature of climate change and the difficulties that it has presented for scientists to persuade the world community about the problem and the need to take action. Robert

    Manne also refers to the difficulty that just at the time when concerted government action is necessary, the public debate from Liberal economists pointed to the need to scale back government. The post WWII consensus associated with Keynes and Bretton Woods was under challenge.

    The problem was particularly acute in the US with funding by oil and energy companies of think-tanks and the ideological Right, which led on to the Tea Party.  John Menadue.

    For this excellent article, see link below:

    www.themonthly.com.au/issue/2015/december/1448888400/robert-manne/diabolical

  • John Menadue. Hoist with their own petard

    Private health insurance funds like NIB are complaining about high specialist fees. But these very same funds are major contributors to the problem. And it is a problem. In the last 30 years we have seen a dramatic increase in specialist fees.

    A major contributor to this increase in specialist fees is the ‘gap insurance’ that private health insurance firms offer. Gap insurance effectively underwrites specialist’s ability to increase fees and weakens Medicare’s ability to cap fees. In the AFR today, NIB gives two examples of how this is done. For prostatectomy (surgical removal of prostate) the Medicare Benefit Schedule Price is $1,939, but with gap insurance NIB offers to cover this up to $2,941. For knee replacements, the Medicare Benefit Schedule Price is $1,318, but with gap insurance NIB offers to cover this up to $2,014.

    But that is not the end of the story by any means.

    The growth of private health insurance makes it more difficult for Medicare to control fees. Instead of the Medicare Benefit Schedule Price capping fees, the Medicare price is just the first stepping stone to higher fees. Whilst NIB will pay up to $2,941 for a prostatectomy, compared with the $1,935 in the Medicare Benefit Schedule, the AMA has a recommended fee of $4,465. And on top of that AMA recommended price, NIB tells us that some surgeons are charging another $6,000. Yet we have a Royal Commission on Trade Union behaviour!

    NIB reveals the same pattern for knee reconstructions. The Medicare Benefit Schedule Price is $1,318 but that is ratcheted up to $2,014 through NIB gap insurance. And then it goes up to $3,960 to the AMA recommended fee. To top this off, NIB advises that some surgeons are charging between $4,500 and $5,500.

    There are many reasons why health costs are rising. Private health insurance companies like NIB and specialists are major contributors.

    The ‘market’ that economists talk about does not work in the health sector. Providers, doctors and hospitals, have the power to set prices as the above figures show.

    With the ‘market’ not working there are really only two ways for governments to avoid price and fee gouging. The first is through price control. That is largely the way that Japan keeps its healthcare costs down. But that approach is unlikely in Australia given our constitution and political situation.

    The second is to have a single public payer to counter the power of providers. That is generally what countries with successful health schemes do.

    Medicare was designed as a single payer. But its power has been diluted by the growth of private health insurance with gap insurance. We are steadily moving down the disastrous US path. And the Australian taxpayer is paying $11 b. p.a. to subsidise these destructive private health insurance funds.

    We should have no sympathy for NIB, BUPA and Medibank Pte about rising costs. They are major contributors to the problem. And they get bundles of money from taxpayers despite the damage they do.

  • John Menadue. Regional cooperation on refugees, Bali and a Track II Dialogue.

    I attended a Track II Dialogue in Bangkok recently to try to help develop a framework of shared responsibility to manage in a humane and efficient manner, displaced people movements in the region.

    There is concern that the Track I Regional Dialogue at government level has not been particularly fruitful. So much of the response to asylum seekers, refugees and displaced people in the region has been ad hoc, fragmented and political.

    The Track II Dialogue included a range of government officials in their private capacities, refugee experts, international agencies and people from think-tanks. The Dialogue was initiated by the Centre for Policy Development in Australia. It now has many additional conveners and supporters including from Mahidol University in Thailand, ISIS Malaysia, the Sydney Myer Fund, the Planet Wheeler Foundation, the Vincent Fairfax Family Foundation, Qantas and Corrs Chambers Westgarth.

    Australia’s successful participation in the Indochina refugee program would not have been possible without the cooperation of regional countries. There were several key elements in that cooperation ,one being that  regional countries would hold Indochinese asylum seekers in safety and facilitate processing. That commitment from regional countries was backed by a broad agreement that countries such as the US, Canada, France and Australia would assist in resettlement. This basic pact between regional countries and settlement countries was messy around the edges, but it worked. My experience with the Indochina program is the reason for my contention over many years that we need to build a regional framework or architecture to manage the flow of displaced people into and within our region.

    But whilst the principles of that earlier pact over the Indochinese outflow are still valid, it is also obvious that no two situations are the same. Most of the asylum seekers from Indochina into South East Asia were in direct flight from Indochinese countries. Many asylum seekers in the region now are not in direct flight but are in transit. There are also many economic migrants in the region who are not asylum seekers but seek improved economic opportunities for themselves and their families. In many ways these displaced economic migrants bring an economic benefit to host countries but their status is irregular and precarious.

    These regional countries face far greater problems over irregular movements than we do. For example in 2015 Malaysia had 272 000 people of concern to the UNHCR, Thailand had 625 000, Indonesia 13 000, Bangladesh 233 000 and Myanmar 1.5 m. Australia had 58 000 people of concern to the UNHCR.

    So the situation faced by regional countries today is different from the situation faced by those countries at the time of the Indochina outflow.

    But there is another major difference. A key to the resettlement of asylum seekers in regional countries in the aftermath of the Indochina war was that relatively wealthy countries were prepared to accept large numbers of refugees for resettlement. The US did the heavy lifting with other countries such as Australia, France and Canada. But now, regional countries cannot rely on this same degree of outside help in resettlement. As regional countries, we have to collaborate and address our problems together. That is not a bad thing but it means building a new framework of regional cooperation.

    Amongst other things Track II seeks to build on the ‘Bali Process’ which was established in 2002 at the initiative of the Australian and Indonesian governments.   Australia then faced an earlier flow of boat arrivals mainly as a result of wars in the Middle East that we involved ourselves in at the request of the US.

    There are now 45 member countries of the Bali Process, including key countries Australia, Indonesia, Malaysia and Thailand. Australia and Indonesia are co-chairs of the Bali Process at both ministerial and official level.

    The Bali ‘process’ has been cumbersome, ad hoc and fragmented. Australia has been a fair-weather friend to the region on refugees. When the Indochina program closed down in the mid 1990s, we left regional countries with responsibilities for many handicapped and disadvantaged Indochinese asylum seekers. After the Bali Process was initiated in 2002, we lost interest when boat arrivals to Australia fell away. In the recent Andaman Sea crisis, when many asylum seekers from Myanmar were stranded at sea, the response from ‘Bali’ was very slow. Many souls died of starvation and dehydration. The Australian government was asked whether it was prepared to help and Tony Abbott infamously said ‘Nope, nope, nope’. This was despite the fact that our Minister for Foreign Affairs was and still is co-chair with Indonesia in the Bali Process. Eventually the Thai government stepped in with support from Malaysia and Indonesia and the desperate people stranded at sea were allowed to land.

    There is quite a way to go in the Bali Process to build a framework of cooperation. It is very clear for Australia and for other regional countries that we cannot manage this problem on our own. There must be shared responsibility and burden-sharing. We need to build trust and a structure that will provide dignity and protection for vulnerable and displaced people.

    The recent Track II Dialogue in Bangkok made the following recommendations to the Bali Process Ad Hoc Group. 

    The Track II Dialogue recommends the Bali Process Ministerial Meeting authorise senior officials to:

    (a) review the response to the 2015 Andaman Sea situation, the resulting caseload, and ongoing maritime movements there and in the Bay of Bengal, within the commitments and principles outlined in the Regional Cooperation Framework (‘RCF’), to share those lessons among Bali Process members and work to implement necessary improvements; and

    (b) Take a broader focus and, drawing on the RCF, make any recommendations necessary to improve national and regional contingency planning and preparedness to enable more predictable and effective responses on forced migration, utilising existing capacity such as in ASEAN, IOM, UNHCR and civil society. Recommendations should reflect the principles that effective policy responses require shared responsibility and distributed capacities.

    The Dialogue offers to support the Bali Process in these endeavours to develop a more effective regional architecture over time.

    These recommendations are made with a view to upcoming fora relevant to the Bali Process, including the UN High-Level meeting on ways to address large movements of refugees and migrants on 19 September 2016. 

    The Bali Process Ad Hoc Group Senior Officials responded positively to the recommendations made by the Dialogue at their meeting in Bangkok on 2 February, agreeing to submit them to Ministers next month in Bali. The Co-Chairs of the Ad Hoc Group Senior Officials released a statement following their meeting, and referred directly to the Dialogue in paragraph [12]:

    The Meeting welcomed an update from the Co-Chairs on the recent meeting of the Track II Dialogue on Forced Migration, held in Bangkok on 29-30 January 2016, and noted recommendations sent by the Dialogue conveners to the Bali Process Co-Chairs. Members agreed to recommend to Bali Process Ministers that officials be tasked to conduct a review of the regional response to last year’s irregular migration events in the Andaman Sea, and share the lessons among Bali Process members. It will also identify recommendations to improve national and regional contingency planning and preparedness to enable more predictable and effective responses on forced migration. Members reaffirmed the importance of engagement with the Track II Dialogue and other civil society, and agreed that the Co-Chairs continue such efforts to engage with key civil society stakeholders.

    Government and non-government members of the Track II Dialogue in Bangkok all showed strong commitment to the overall process and to maintaining involvement to build an architecture of regional cooperation to manage and assist people displaced in the region.

    The next two meetings of the Track II Dialogue will be held in Malaysia in September 2016 and Indonesia in early 2017.

    The Track II Dialogue is already providing a flexible, sustainable and credible platform for regional cooperation and for influencing government policy. Good progress has been made, but a lot of work remains to build a regional framework/architecture.

    What is critical is not the process of consultation but practical and humane outcomes.

    Further information about the Track II Dialogue and its second meeting in Bangkok is available on the CPD website here.

    https://cpd.org.au/2016/02/secondadfmmeeting/

  • John Menadue. Part 2. How we deliver healthcare is as important as the funding of healthcare. Medicare has degenerated into a payments system.

    In Part 1 I focussed on the importance of improving the delivery of health care and not just funding.

    In Part 2 I will focus on specific areas where costs should be reduced.

     

    Part 2

    Getting costs down

    • The government should abolish the subsidy for private health insurance which costs all up about $11 billion p.a. This welfare subsidy is one of the fastest growing areas of Commonwealth government health expenditure. We have never had high income welfare recipients on such a scale before .PHI is the Damocles sword hanging over our health system. PHI is the reason for the disastrous American health system. High levels of private health coverage in Australia are achieved not through the attractiveness of the products on offer but mainly through the carrot of the tax subsidy and through the stick of penalising the uninsured. The subsidy favours the wealthy, is inefficient, has underwritten rising specialist fees through gap insurance, has not taken the pressure off public hospitals and has weakened Medicare’s ability to control costs. PHI discriminates against country people where there are few private hospitals. The immediate abolition of this subsidy would do more to improve our health system than anything else. This is welfare big time- far more than the welfare we used to pay to the motor industry. The abolition of the $11 b. subsidy would more than fund a universal dental scheme. Alternatively, say $5 b. of the saving by abolishing the subsidy could be paid directly to private hospitals through an activity based funding arrangement. It is absurd that public funds should be churned through high cost private health insurance rather than being paid directly to hospitals. Before the Howard government, Commonwealth government funds were paid directly to private hospitals, but this was discontinued. Direct Commonwealth funding for both public and private hospitals would also substantially improve the integration of hospital care. But private hospitals would oppose this because they find it much easier to twist the arms of private health insurance companies. And some of the major hospital groups, particularly Ramsay, are generous donors to the Liberal Party.
    • We need a more productive workforce. Health is the largest and fastest growing sector in the Australian economy. Despite all the talk of improving productivity in Australia no-one has been game to take on the entrenched privileges in the health workforce.Where is the honesty and consistency here? The blue collar workforce is fair game but not doctors and lawyers. We need expanded roles across the board particularly for nurses, pharmacists, allied health workers and ambulance officers. The Productivity Commission in its February 2007 report estimated that a 5% improvement in the productivity of health services would deliver savings of about $3 billion p.a. This is a very conservative estimate. The health sector in Australia is rife with demarcations and restrictive work practices. eg 5 % of normal births in Australia are delivered by mid wives. In the Netherlands it is 70%, in the UK 50% and in NZ 95%. We have a few hundred nurse practitioners when there should be thousands. The work practices in most industries are light years ahead of the work practices in the health sector.
    • Fifteen years ago 45% of doctors were GP’s. It has fallen to about 35% yet we know that care is most equitably and efficiently delivered by GP’s. Specialists are reactive and we all know they have become very expensive thanks to gap insurance provided by private insurance companies.
    • We could save about $2 billion p.a. in drug costs if we paid drug suppliers the same prices that are paid in NZ. We also pay a high price for the protection of pharmacists through the 5000 limit on the number of community pharmacies and the restrictions on where new pharmacies can be located. Pharmacies cannot be established in supermarkets.
    • We need to raise productivity in our hospitals. The Productivity Commission suggests that the productivity gap in best practice in public hospitals ranges from 3% to 89%. In private hospitals the range is 22% to 37%. There are major governance problems in many hospitals with a dis- connect between management and clinical functions. Running hospitals is very difficult with clinicians coming and going from private practise like the cottage industries of old.
    • The Commonwealth/State fragmentation in healthcare results in blame-shifting, the evasion of responsibility and higher costs. If for example the Commonwealth Government or a joint Commonwealth/State body had responsibility for all health care funding in a state or region, there would be a clear incentive to focus on treatment in the community and in homes to ensure that the high cost hospitals are really a last resort. The National Health Performance Authority found that in 2013/14 over 600,000 hospital admissions for 22 conditions could have been avoided with timely interventions in the community, mainly by GP’s. But the problem in doing this is that the Commonwealth government funds general practice and state governments operate hospitals.
    • The real elephant in the room in health care cost reduction is avoidable mistakes, including deaths. They are euphemistically called “adverse events”. But Ministers, clinicians and managers do their best to avoid the issue. Based on earlier surveys in NSW and SA I estimated, very conservatively the cost of avoidable mistakes in our health sector at $5b pa (see my blog of June14, 2013). Despite a great deal of money and effort there is no sign of improvement. Insiders won’t solve the problem Good people are caught in a bad system.
    • Only last week, Medibank Private said that $800 m. p.a. could be saved if a reference pricing system with Australian and global benchmarks was introduced for prostheses such as for hip and knee replacements, plates and pacemakers. Medibank Private said that prices for identical products could be 45% lower in the public system compared with the private system. With differentials like that it is no surprise that private health insurance premiums have increased at three times the rate of inflation.

    The quality of our health care is generally good but waste and inefficiency is deep and widespread.

    We need to address waste and costs in a measured way. We should not panic, but we should get it done. Australian healthcare costs are 9-10% of GDP. This is not high by world standards. It is below the OECD average. A major reason why we have been able to do better than others is that we have Medicare as a public insurer. One lesson is clear all around the world. The countries that have high levels of private health insurance, like the US, have high costs.

    A fundamental problem in the health sector is the way we deliver healthcare. But we keep focusing only on funding. We have a horse and buggy health delivery system that is unfit for the 21st Century. Medicare takes that horse and buggy delivery system as a given.

    I have almost given up hope that the ALP will restore Medicare to what was intended, a single payer and a strong public insurer.

    The vested interests don’t want change in the way we deliver health care. They must be delighted to see how gutless the ALP is.

    More and more money will not necessarily improve the delivery of health care and neither should we expect it to. It will mainly entrench a lot of bad habits and the position of vested interests.

     

  • John Menadue. Privatising Medicare’s payments system and the erosion of Commonwealth Public Service capability.

    The government has apparently accepted the advice of the Commission of Audit that Medicare’s payments system should be reviewed with the possibility of privatisation. The payments system includes Medicare, the Pharmaceutical Benefits Scheme, Aged Care Services and Veterans’ Affairs.

    It sounds like another expression of neo liberalism, that only the private sector can be efficient and cost-effective.Let us see whether that is so through market testing. I remain sceptical.

    As a regular user of Medicare services and payments, I am not aware of problems in the payments system. But if there are problems, the government should fix them.’.

    This proposal on privatizing Medicare payments is part of the continuing trend to degrade government capability in both policy and administration of programs. The Australian Public Service is becoming short of senior people who understand the complex world of business strategy and those things required in commissioning the delivery of services or planning infrastructure investments and their delivery. In social policy it is not at all clear that the Commonwealth now has the people who understand the big systems that are so essential to a large part of what the public sector does.

    In between jobs, the new Secretary of PM & C put the problem this way in an interview with Laura Tingle in the AFR in May 2015. He said:

    ‘I think our institutions are being eroded in their capability and eroded in public trust. … Over time large parts of the public service have lost their policy development edge.’

    He has been replaced in Treasury by John Fraser, most recently a banker. Yet much of the governments’ deficits around the world have occurred as a result of governments having to bale out the banks for poor decisions and poor risk management.

    The problems that we apparently have with Medicare are common to many agencies. Good accounting in government has been abandoned and replaced with narrow financial metrics. Outside a few agencies, there just isn’t the capacity to do proper cost/benefit analysis. Many decisions are made on the run on the basis of cash outlays over four years.

    This failure of government administration suits private providers who exploit ministers’ and bureaucrats’ lack of analysis capacity and the domination of short-term cash outlays in the public presentation of the budget.

    It also suits neoliberals to get as much off the budget as possible even if the community is worse off. This is happening in the health sector. Some government expenditure is relieved by pushing business towards private health insurance, but we know that administrative costs of private health insurance are three times higher than Medicare. Furthermore we know that the growth of private health insurance makes it harder for Medicare to control fees. So whilst the budget may look a little better, the community is much worse off.

    We have had glaring examples of how government policy, capability and operations have been run down to the benefit of accounting and consulting firms who come and go with projects and their ‘economic models’, but there is little building of intellectual capital in the process.

    Staff numbers in the Australian Taxation Office have been cut back at a time when we have record tax avoidance and hundreds of our major companies paying no tax at all.

    I have rarely seen a root-and-branch criticism of a department as we saw with the Australian Public Service Commission Capability Review of the Department of Health and Ageing last year. The Secretary of the Health and Ageing at the time is now Secretary of Finance.

    The Department of Immigration and Border Protection has become securitized with a focus on border protection and control at the expense of nation-building and humanitarian programs. Senior and competent people with knowledge in nation-building and refugee programs have left the department. We see the result most graphically in the snail-pace response to settling 12,000 refugees from Syria. Less than 10 have arrived! Canada has put us to shame.

    The Attorney General’s Department failed to tell security agencies about the risk of Mann Haron Monis weeks before he entered the Lindt Café. The Attorney General’s Department has carriage of the policy and implementation of ‘meta data’ through the Data Retention Act. We were told at the time it was urgent because of the terrorist threat. But the policy cannot be introduced until the end of 2017at the earliest because of flawed implementation. AG’s department has just not been up to the job.

    One reason for the pink batts problem was the loss of  implementation capability in the Department of the Environment. That same department has bungled the approval of the Carmichael mine.

    The Department of Defence is subject to very little effective checking of its very expensive capital projects. It keeps making the same mistakes. As John Stanford put it in this blog on 11 December last year

    ‘Our defence acquisitions keep repeating the mistakes of the past, from mixing and matching systems inappropriately and accepting excessive risks, to allowing political judgements to override efficiency considerations and the proper regard for the public purse. In the new submarine acquisition, we seem to have learned nothing from the Collins Class procurement’.

    When the new submarines are delivered China and India will have nuclear submarines.

    The Department of Defence has a one-line budget appropriation which effectively denies rigorous examination of mega-dollar projects by the Department of Finance and others.

    The sorry story continues with the mega funding of roads. As Mike Keating and Lucas Fraser pointed out in the policy series in last year’s blog

    ‘A reasonable projection of planned road expenditures indicates that the accumulated stock of debt to FY 2023-24 could be of the order of $114 b. When added to the already accumulated debt, this amounts to a total accumulated road-derived public sector debt of $140 b. within a decade, a matter than until now has been entirely unreported’. Where is the Department of Transport or Infrastructure Australia when we have such gigantic and wasteful expenditures on roads”?

    There is a dismal and concerning story about how the capital of government is being deliberately eroded.

    We are paying a very heavy price for neoliberalism and the down-sizing of government that goes with it. The selling of Medicare’s payments system may be another step along this path.

    The coinage of the Australian Public Service is being seriously devalued. Can the threads of good policy development and administration be recovered? It is getting late.

  • John Menadue. Part 1. How we deliver health care is as important as the funding of health care. Medicare has degenerated into a payments system

    Part 1 of these articles will focus on the inefficient way we deliver health care, the many perverse incentives and the power of vested interests to resist reform in health care delivery.

    Part 2 will focus more particularly on examples of waste and inefficiency in health care delivery

    Part 1

    We have been told many times that our health system is unsustainable.

    To justify its case for an increase in the GST, the government was telling us that an increase was necessary because of rising costs in health and education. Now the GST is apparently off the table as Malcolm Turnbull retreats on yet another issue.

    Some premiers and commentators suggested that an increase in the Medicare levy was best because it was fairer than an increase in the GST. And we will hear a lot more from the premiers about health because the Abbott Government said it would cut $ 80 b from grants to the states for education and health over the next decade commencing in 2017

    But what is being avoided in all this confusion about budget repair and health costs is that there is no real discussion about the waste, inefficiency and low productivity in our health sector. We continue to focus on the funding of our health sector, but refuse to debate how the delivery of care – its cost and safety – can be improved. Medicare is overwhelmingly discussed in terms of funding only. It should also be about how those funds are spent to improve the delivery of health services. Basically Medicare funds an existing system of health care delivery. That needs to change.

    There are three main reasons for our failure to address the delivery problems in health care.

    The first is the power of the vested interests. These vested interests fight doggedly and selfishly to maintain their privileged position in health delivery. The principle vested interests in health are the AMA, the Pharmacy Guild of Australia, Medicines Australia and the private health insurance sector. In an earlier blog I said that the Health Ministers may be in office, but they are seldom in power. The vested interests –the providers- are really in power.

    A second reason for the failure to focus on delivery of health services is that politicians are afraid of the vested interests – doctors, pharmacists, pharmaceutical manufacturers and suppliers, and the private health insurance sector.

    The third reason is the failure of economists and other commentators to consider efficiency in the delivery of health services. These economists talk continuously about the need for appropriate incentives, but in the health sector many of the incentives are quite perverse – such as fee for service.

    As Ross Gittins put it in a recent SMH article, ‘Like so many of the interest groups, econocrats are obsessed with funding education and health rather than ensuring both systems are working in ways that have found a good trade-off between fairness and efficiency, and effectiveness.’ … See link to article.

    These economists that we hear and see so often in the media are mainly employed by the banks. They have little or no knowledge or interest in health economics. They tie themselves in knots over the need for IR reform and improvements in productivity in the workforce generally. But over the years I have never heard any of them address the appalling work practices and demarcations in our health sector which really go back to the 19th Century. Yet our health and welfare sectors employ 13% of our workforce, the largest sector by far. It is also the fastest growing. At its worst, our waterfront never had the appalling work practices and demarcations that still persist across our whole health sector. Clinicians justify our archaic work practices on the grounds of safety when it is really territory they are defending.

    Economists are yet to grasp that health consumers have little power over prices or quality of care. Power is with the providers-doctors, pharmacists, drug distributors and private hospitals. That is why a strong public insurer is essential to counter the power of providers. If there is not a strong public insurer we will follow the disastrous path of the US that has the most expensive and unfair health system in the world. But our economists who say they believe in markets will not recognise the failure of the health ‘market’.

    On 4 Corners several months back, Norman Swann suggested that waste in health expenditures could be as high as 30% of our total health expenditures. I think that estimate may be on the high side, but it is clear that there are excessive costs. – see link to article ‘Four Corners: No wonder we’re wasting money in health care – we got the incentives wrong’ by Jennifer Doggett, Ian McAuley and John Menadue.

    In a paper in July 2007 I estimated that there was at least $10 billion in possible savings and productivity improvements in health. That represented about 10% of our total health costs in that year. I think it would be nearer 20 % or $ 30 b per annum. I have spoken and written extensively on this matter.

    The lack of accountability in health

    Despite the rapid increases in costs and escalating demand in the healthcare industry, there is no accountability in any meaningful way for what the health industry delivers. Doctors are accountable for malpractice but not for their overall performance particularly in general practise. Accountability is patchy in many private hospitals. Taxpayers have a legitimate reason to ask – ‘Are we getting value for money particularly when we pay 80 % of doctor’s incomes.’ In a survey several years ago by the Health Council of Canada, 97% of over 1,800 senior respondents said that healthcare providers should be required by law to reach certain service benchmarks in such areas as patient outcomes , the use of preventive strategies like screening and waiting times. There is the same lack of accountability in Australia.

    The Council also asked the group ‘Do you believe healthcare in Canada will improve if the government spends more money on healthcare?’ 58% said ‘no’.

    Managing the demand for health services

    The demand for health services is increasing rapidly across all age groups and not just among the old. We are over-diagnosed and over-treated. In 1984-85, medical services per head were 7.1 per annum. In 2007-08 they were 13.1 per annum – about double. The trend continues.

    • We must accept that we cannot have all that we want in health and that governments, in consultation with the community, have to set priorities. Can we afford continuing existing levels of funding for IVF and end-of-life treatments at the expense of funding for mental health and indigenous health?
    • We need to rationalise our co-payments to make them efficient and equitable. We all should take more responsibility for the way we use health services, particularly as we are now much wealthier than we were 30 years ago when Medicare was introduced. A universal health scheme does not have to be free. But it must be fair and efficient. But co-payments are a dog’s breakfast! We pay about 18% of health costs out of our own pockets, but there is very little rhyme or reason in how this is done.
    • The best way to curb the long-term growth in health spending is through prevention in such areas as alcohol, smoking, junk food and obesity. Our sporting, alcohol and junk food sectors are in a joint enterprise to promote poor health. But the first action of the Abbott Government in its first budget was to abolish the Australian National Preventive Health Agency which was focussing on lifestyle risk factors.
    • We need to change the perverse incentives, such as fee-for-service, which is associated with bulk-billing. Clinicians are rewarded by the number of transactions rather than health outcomes. It promotes what is called ‘turn style medicine’ FFS is particularly inappropriate for chronic care, mental health and services with high fixed costs and low variable costs, such as imaging. The government should move away from fee for service and set budgets for general practitioners when they prescribe drugs, order pathology tests or imaging services. We need more doctors on salaries and capitation payments for caring for patients-not on a service by service basis. Hopefully, the Medicare review will grasp this nettle.
    • We need to tackle the wide variations in the incidence of clinical practice across the country, e.g. caesarean sections and cataracts. In the Australian Atlas of Health Care Variations the Australian Commission on Safety and Quality in Health Care found ‘substantial variations in health care use in areas such as antibiotic prescribing, surgical, mental health and diagnostic services’ Medicare should be much more proactive in exposing and limiting very expensive and inexplicable variations in clinical practice. .It also needs to publish the enormous variations in doctors fees and particularly the fees of specialists. Better public data for greater transparency is essential.

     

     

     

  • John Thompson. Fiona Nash and private health insurance for rural Australians

    Screen Shot 2016-02-11 at 4.04.29 PM

    A few nights ago on Q&A, the Minister for Rural Health, Fiona Nash, undertook to drop out of private health insurance while she was in office. Ms Nash lives in Crowther, a small town about midway between Wagga Wagga and Bathurst. Foregoing private health insurance makes a lot of sense for her because, like most rural and regional people, she pays a large amount to private insurers and has very limited access to private hospitals and related private services in her area.

    The map above shows why rural people are especially short changed with the private health system. The brown markers indicate public hospitals and the private hospitals are shown by purple markers. Crowther is almost in the middle of the map – 180 kms from Wagga Wagga and 141 kms from Bathurst.  There is one private hospital in Wagga Wagga and one in Bathurst, and neither has an emergency department. [On my count, there are about 30 public hospitals in this area. JM]

    The private health system is one of the most expensive Commonwealth Government programs.  In 2016/16 direct outlays by the Commonwealth Government will be $6.3 billion and income tax foregone will amount to $4.2 billion, a total of $10.5 billion for the year.

    Ms Nash, as a Nationals Party representative, should recognise that the private health system is particularly costly for her rural constituents because they are getting such a very raw deal. They are paying large sums directly to the private insurers and similarly large sums in taxation to support those insurers.  And they are getting very little in return.

    Rural Australians should ask themselves what they are getting for the large sums they are paying, both directly and through their taxes, to private insurance companies, and perhaps follow the lead of their elected representative, the Minister for Rural Health.

    John Thompson is an economist with an interest in health policy.

  • Jim Bowler. Mungo Man needs help – to come home

    It’s time for funds and a plan to preserve and commemorate this visitor from Ancient Australia, writesJim Bowler, the geologist who discovered Mungo Man’s remains.

    Forty-two years ago, on 26 February 1974, I first encountered the remains of Mungo Man eroding out of the desiccated shores of Lake Mungo. He had been ritually buried over 40,000 years earlier – at a time when the lake was full – by an ancient community that thrived in the fertile environment. The re-emergence of Mungo Man has changed the way we understand Australian history. Together with the earlier (1969) discovery of Mungo Lady, these burials provided the foundations on which the Willandra Lakes World Heritage area was defined and accepted by UNESCO in 1981. That region stands today as Australia’s richest legacy of early occupation. Yet forty-two years later, after decades of constant calls for the return of Mungo Man, none of the responsible state and federal ministers have committed to caring for these sacred remains.

    In November last year, a repatriation group of Indigenous representatives took the first step towards Mungo Man’s return. The 40,000-year-old human remains, along with the more fragmentary remains of some ninety other individuals from the Willandra Lakes area, were transferred from the Australian National University to the interim storage of the National Museum of Australia. After years of frustration, the traditional owners of the Willandra Lakes area – the Mutthi Mutthi, Ngiyampaa and Paakantji tribal groups – reluctantly decreed that unless appropriate keeping arrangements were made by the end of 2017, they will dispose of all Willandra remains, with the possibility of complete reburial. The possibility that the remains of Mungo Man may not be laid in a formal place – an underground sacred crypt with above-ground recognition of the dead, perhaps, in memory of deceased Elders and of those thousands who fought in defence of their lands – should stir the nation’s conscience.

    Mungo Man is acknowledged worldwide as the centrepiece of our evidence of ancient Australia. He has featured in documentaries, novels, histories and scientific papers, and he has given us an insight into life in ancient Australia through paleopathology, DNA analyses, and studies of isotopic bone and teeth structures. Moreover, the ritual nature of his burial has changed our understanding of the time-depth and complexity of Aboriginal culture. The body was coated (or heavily sprinkled) with rare ceremonial ochre – the blood-red symbol of life – which had been imported from distant sources. His grave was associated with a nearby hearth, from which smoke might have drifted over the assembled mourners on the lakeshore. The discovery stands without equal on the global stage. Politicians who frequently claim occupancy with members “of the world’s oldest continuing cultures” are denying a keeping place to the very person who provided the historical substance of that claim. The Australian nation awaits his return home.

    In Mungo Man, the interaction of climate and people come together. The cultural implications of his burial reflect complex relationships with his environment. The central function of ochre, the association with fire, and the careful details of the grave emplacement combine to define a community with connections to the land they loved. Such evidence resonates with Aboriginal connections to country today. There is great dignity here in that people–land relationship. Exemplified today in the Dreaming, song lines and creation stories, it remains of central importance in helping define traditional people’s identity with and connection to the place they call home. White Australians have something important to learn from our Aboriginal cousins.

    Stan Grant’s passionate reminder of our shameful treatment of Aboriginal Australians, and subsequent discussions of our national identity have touched new sensitivities in the fraught relationships between Aboriginal and white Australia. Two centuries of failure to acknowledge the magnitude and pain of dispossession have come back to confront us. The neglect of the human remains of Australia’s oldest identity, Mungo Man, adds yet another dark stain to our relationships with the first Australians. We now must seek new opportunities to restore fractured bonds, to help heal at least part of the pain inflicted on the original occupants of this land.

    This year marks the centenary year of the Somme and we honour the memory of those who died on the Western Front during the first world war. It is where my father spent two harrowing years navigating duckboards and dodging shell holes in Amiens and Villers-Bretonneux. A century later, the deaths of the tens of thousands of Aboriginal men and women who died in defence of their land await their memorial occasion. The continued absence of facilities in memory of Mungo Man and all he represents pales against the $100 million Villers-Bretonneux Educational Centre Tony Abbott unveiled last year. While the honouring of our war dead is essential, what is sacred in France demands equality at home.

    Unless immediate steps are taken to ensure adequate accommodation for sacred items that amplify and help define the meaning of human occupation of this continent, the iconic figure of Mungo Man could be lost forever. We have but eighteen months to ensure safe passage. The repatriation process needs realistic funding and a discretionary commitment to World Heritage management to ensure it takes place. Without state and federal assistance, the Indigenous repatriation group will be forced to rebury the remains of Mungo Man instead of preserving them for future generations in a sacred keeping place.

    We are dealing here not just with an assemblage of ancient bones, but with the dignity and cultural richness of our Aboriginal brothers and sisters. As a nation, we need to seize this opportunity to release Mungo Man from his custody. The return and celebration of Mungo Man will set us on a course to heal those bleeding wounds Stan Grant so eloquently defined. It is an act of recognition to Indigenous Australians of the nation’s debt to their ancestral history.

    Jim Bowler is a professorial fellow at the University of Melbourne’s School of Earth Sciences. This article was first published in Inside Story on 9 February 2016.

  • The Pope is not the only one who doesn’t get it.

    This is an extract from Robert Mickens’ ‘Letter from Rome’ of 10 February 2016, published in Global Pulse.  In the full article, Mickens refers to the extraordinary success and acceptance of Pope Francis in so many areas. There is however a downside. Mickens coments:

    But there is a dense cloud hanging over all the good this prophetic priest and bishop has done for the Church. It is a pall that is casting an ever darkening shadow on his otherwise energizing pontificate.

    The black spot is – how can one put it? – the pope’s seemingly ambivalent attitude and approach towards dealing with clergy sexual abuse of youngsters.

    Just to be clear. Francis ticks the boxes favorably in over 80% of the categories where a pope can make a difference. But there are some areas – and the sex abuse issue is probably the most painful – where he doesn’t seem to get it.

    And that is a real tragedy.

    Thankfully, Vatican apologists are no longer making the ridiculous claim that the sexual abuse crisis (let’s call it what it is, a worldwide pandemic) is a priority for the pope.

    Even the apologists need to look themselves in the mirror and admit that it is not.

    If it were, the pope would have at least made time to meet with the 17-member Pontifical Commission for the Protection of Minors that gathered last weekend in the Vatican. This is a body Francis instituted in 2014, but only after he was shamed into doing so by Cardinal Sean O’Malley, a member of his privy council (C9) and the US Church’s sex abuse trouble-shooter.

    But the Jesuit Pope seemingly had more important things on his agenda, like addressing devotees of the mysterious and still-controversial St Padre Pio, one of two Capuchin saints whose fully clothed corpses were brought to Rome last week and paraded through St Peter’s Square in glass boxes.

    Francis was also unavailable to see “Spotlight”, the recent film on the Boston Globe’s investigative reporting that helped bring clergy sexual abuse to light.

    The filmmakers offered a private screening for members of the Vatican’s child protection commission (the flick is not out yet in Italy) but only five of the seventeen bothered to show up.

    Five!

    One of them was Peter Saunders, a Brit who was sexually abused by a priest when he was a boy. The other members then voted Mr Saunders off the commission because, in their view, he’d rather be an advocate for the victims than an advisor to the pope.

    Obviously, Francis is not the only one who doesn’t get it.

     

  • David Isaacs. Secrets and lies and bad morality: Australia’s policy on people seeking asylum

    The latest episode in the long, sorry saga of how badly we can treat people seeking asylum was played out in the High Court in February 2016. Long because the story started in 1992 when the Paul Keating Labor government introduced mandatory detention ‘as a temporary measure’ in reaction to a handful of people arriving in leaky boats from Cambodia. And I use the term ‘people seeking asylum’ advisedly, because the term ‘asylum seekers’ dehumanises the people and has been shown to cause Australians to switch off. The High Court found it is legal for the Government to send babies born in Australia and children and adults transferred to Australia for mental health and other problems back to Nauru. This decision was predictable because the Government passed retrospective legislation making it legal. As the human rights lawyer Daniel Webb put it so eloquently, the law is complex but the morality is simple. Bad Governments pass bad laws to allow them to do things that are morally wrong. I am a doctor not a lawyer, so I am not qualified to say at what point the High Court has a duty to make sure our Government does not exact really heinous legislation, but this is pretty bad. Excising Christmas Island from the mainland and sending people into detention centres on Nauru and Manus Island is our Guantanamo. These are ‘black sites’ where people can be severely mistreated under a veil of secrecy: out of sight and out of mind.

    To argue that people are now free to come and go from the detention centre on Nauru is disingenuous. They are not safe if they leave the detention centre and they are not safe in the detention centre. Their visas to stay on Nauru are restricted to 5 years, so their future is as uncertain as ever. Nauru is their prison. Mr Dutton has stated that the hospital on Nauru is comparable to Australian hospitals. I did a clinic at the Republic of Nauru (RON) Hospital in December 2015 and it is far, far worse than any Australian hospital I ever visited. Furthermore, the staffing is as important as the facilities and the RON Hospital struggles for qualified staff. Of course, Mr Dutton will argue things have changed in the last year. Verifying the truth is impossible when the only journalist allowed in for years was a single Murdoch Press Government sympathiser and doctors who speak out risk two years in prison.

    Ethics can be defined as ‘how we ought to behave’ and medical ethics as how health professionals ought to behave. I recently published a paper (available on request) in the Journal of Medical Ethics (http://jme.bmj.com/content/early/2015/12/20/medethics-2015-103066.abstract) in which I argue that prolonged immigration detention fulfils all the criteria for torture. I then argue that doctors and other health care professionals are conflicted: they have a duty to their patients to help them but they also have a duty not to condone torture. The US Central Intelligence Agency (CIA) argues to this day that water-boarding prisoners in Guantanamo and Abu Ghraib was not torture because the technique was devised by psychologists and supervised by doctors. The doctors would presumably argue that the water-boarding was going to happen anyway and they were ensuring the prisoners did not drown. Highly respected colleagues and lawyers have said to me “Nauru is not as bad as Guantanamo”. Is it not? Are we to have degrees of torture? There have been unconfirmed (probably unconfirmable) reports by a guard of water-boarding and ‘zipping’ being inflicted on people in immigration detention in Nauru (http://www.abc.net.au/news/2015-08-14/guard-tells-parliamentary-inquiry-asylum-seekers-tortured-nauru/6699162). Why would the guard lie? Mr Dutton denied it, but he would wouldn’t he.

    The harms we are inflicting on adults to punish them for having the temerity to flee persecution in their homelands are immoral. We treat innocent adults worse than we do convicted criminals. But the public are more likely to sympathise with the argument that children are innocent victims. Gillian Triggs realised this, which is why her Forgotten Children enquiry is so powerful. Alison Light, in her wonderful book “Common people”, describes how the 19th century English workhouses were intended to punish men who did not want to work, but the biggest victims were women and children. I was struck by the parallels with immigration detention centres. I am proud that increasing numbers of paediatricians and paediatric nurses have decided to speak out against what is being done to children by our Government in our name. Alanna Maycock, Hasantha Gunasekera, Karen Zwi and Josh Francis have all risked imprisonment for telling the truth.

    What should happen? The Government mantra, ‘We’ve stopped the boats’, means the immigration detention centres are redundant. Keeping people imprisoned can only be to deter other desperate people from seeking asylum. Europe, struggling with a far bigger immigrant problem, has not resorted to such vulgar deterrent policies, although extreme right wing European groups cite Australia as an example to follow. We should allow the derisory number of children to remain in Australia with their parents. We should close the detention centres on Nauru and Manus, which are not only immoral but hugely expensive (it costs over half a million dollars per year for each person kept on Nauru). Mr Turnbull committed his Government to a tough stance on border control. If that stance includes continuing to torture innocent people we should hang our heads in shame.

    Professor David Isaacs is Senior Staff Specialist, Department of Infectious Diseases and Microbiology and Clinical Professor of Paediatric Infectious Diseases at the University of Sydney. He works at the Children’s Hospital at Westmead.

     

  • Ravi. Poems from detention.

     

    My pen and paper

    I walk a deep sadness path with my loneliness. This emptiness makes me slow.
    I fall to my knees and cry out loudly.
    Tears knock silently at my eyes.

    I can’t find anyone to share my pain with so I make friends with my pen and paper. I share with them all my pain.
    They cry with me.

    The paper becomes wet with their tears.

    • Ravi

     

    Feelings of Loneliness

    I am alone
    very alone.
    And this is what alone is:
    To be nothing
    To have nothing
    To hurt so badly
    Aching not only in your heart
    But in every cell of your body.
    I am ignored,
    utterly unnoticed,
    thrown aside
    as a completely uncared for orphan.
    And friendless
    because they’ve all gone.
    Their love,
    their smiles
    all gone.
    I was left behind
    with no one to walk with.
    Oh how I want them back! With no friend to see or hear my agony I cry.
    With all possibility of hope
    vanished
    sorrow moves in to love me.

    After travelling to Australia from Sri Lanka by boat, Ravi was detained in Nauru Regional Processing Centre and Melbourne Immigration Transit Accommodation for over three years. He is now living in the community and has published a collection of his poems written from within our detention centre system.

     

  • John Menadue. The collapse of the Malaysian Arrangement has led to the depravity of Manus and Nauru.

    Having done its best in Opposition to wreck the Malaysian Arrangement in 2011, the Turnbull government is now seeking the help of Malaysia over detainees in Manus and Nauru. For political cynicism, this is hard to beat.

    In May 2011, the Australian and Malaysian governments announced an ‘in principle’ arrangement that up to 800 boat arrivals would be transferred from Australia to Malaysia for their asylum claims to be heard. In response Australia would be prepared to accept 4,000 refugees from Malaysia. The arrangement with Malaysia was signed on 25 July 2011. The UN High Commissioner for Refugees gave it qualified support. At that period, boat arrivals were running at four to six per month.

    The Gillard government introduced legislation to give effect to the arrangement with Malaysia which was necessary as a result of a High Court decision on the transfer of people. That legislation was bitterly opposed by the Coalition and others in an evenly divided House of Representatives. The legislation failed in September 2011 when boats were running at only four in the month.

    In this opposition to the Malaysian arrangement, the Coalition was actively supported by the Greens and some key NGOs.  The Greens and the NGOs wanted more than was on the table and finished with nothing – or something worse – Manus and Nauru. NGOs need to be politically astute and consider government’s responsibilities on security, economy and society. Or as Gough Whitlam put it pungently in another context. ‘Only the impotent are pure’.

    Failure to pass the legislation to implement the Malaysian Arrangement opened the door for people smugglers to really get to work. As a result of the failure of the Malaysian Arrangement, boat arrivals rose from about four or five a month to 48 in July 2013. Tony Abbott and Scott Morrison were not interested in stopping the boats. Their political objective was to stop Labor stopping the boats.

    Having helped defeat the legislation in the parliament, Tony Abbott and Scott Morrison seized every opportunity to bash Malaysia’s human rights record and ‘canings’.

    But now we find that despite this history, the Turnbull government is now discussing with Malaysia ways to resolve the Manus/Nauru mess, a situation which no-one believes is sustainable. Consistent with what I have heard in the region, Laura Tingle in the AFR on February 4, 2016, said

    ‘Now it emerges that we are once again talking to Malaysia – the country with whom the Labor government was doing a deal … which was supposedly so abhorrent to the Coalition and the cause of human decency. ‘

    We have gone cap in hand to the Cambodian government and paid it over $50 million to resettle four refugees from Manus/Nauru. Our government has also been in discussions with the Philippines and Kyrgyzstan but without success. Now the government is talking again to Malaysia which Tony Abbott and Scott Morrison reviled in 2011.

    Tony Abbott helped to keep the door open for people smugglers by successfully but unscrupulously contributing to the defeat the Malaysian Arrangement.

    The Malaysian Arrangement was not ideal, but it would have significantly helped manage the flow of desperate people. It would also have been a building block for a regional framework which is necessary to manage displaced people in our region.

    I will be writing further about the importance of this regional framework.

    The result of the failure of the Malaysian Arrangement is the depravity of Manus and Nauru. Political cynicism has been exposed but at great cost to very vulnerable people.

    We have become a pariah in our treatment of asylum seekers.Even if we are stuck with Manus and Nauru for a while yet, there is no excuse for the Australian Government allowing detainees being treated so inhumanely.

    See link to earlier articles, Parts 1 and 2,  I wrote with Peter Hughes on this subject ‘Slogans versus facts on boat arrivals. Part 1’. See also post ‘Slogans versus facts on boat arrivals. Part 2’.

     

  • John Menadue. ‘We don’t have a revenue problem, we have a spending problem’.

    Treasurer Scott Morrison has been expounding the above philosophy of his for months. But he couldn’t be more wrong. Unfortunately the Secretary of Treasury has now followed up with nonsense that Australia should have a ceiling of 25% of GDP on government spending (I assume he is referring to Commonwealth Government spending).

    Michael Pascoe (Michael Pascoe on Page 21 of February 03, 2016 issue of Sydney Morning Herald) nailed the ideological clamour and suggestion that lower levels of government spending result in improved economic performance and that Australia has a high level of government spending that should be reduced.

    In the article, Pascoe says ‘What can be clearly shown is that there is no correlation between relatively low government spending and the very best possible credit rating.’ Pascoe produces the latest figures from the ‘right wing’ Heritage Foundations 2016 Economic Freedom Index, which compiles all government spending – federal, state and local. This article points out that Australian Government spending is running at 35.6% of GDP. He adds that almost all countries with AAA status from Standard and Poor’s, Moody’s and Fitch, have higher government spending as a proportion of GDP than Australia: Australia 35.6%, Canada 40.7%, Denmark 57.1%, Germany 44.3%, Hong Kong 17.6%, Luxembourg 43.6%, Netherlands 46.8%, Norway 44%, Singapore 18.2%, Sweden 53.2%, Switzerland 33.5%.

    These figures make it clear that high levels of government spending do not necessarily result in poor economic performance. Pascoe concludes ‘It turns out that having markedly higher government spending isn’t so necessarily disastrous after all.’

    In a submission to the Senate Select Committee into the Abbott Government’s Commission of Audit, Jennifer Doggett, Ian McAuley and I contend that the problem is not that government expenditures or that the public sector is large in Australia compared with other countries. We contend that the problem is a short-fall of revenue and that on international comparison, our tax revenues are low.

    In our summary to the Committee we say …

    The Commission of Audit’s brief is based on assumptions that Australia is burdened with “big government” and that taxes are an impediment to business investment and workforce participation.

    There is no evidence for either assumption. The trend in Commonwealth expenditure has been downwards since the mid 1980s, falling from a peak of around 28 percent of GDP to a range of 24 to 26 percent of GDP in recent years. In comparison with similar prosperous countries Australia has one of the smallest public sectors.

    The problem a body such as the Commission should address is our inadequate tax base, which is the main reason the Commonwealth has had a structural deficit for most of this century. We aren’t collecting enough revenue to fund the public services needed if the economy is to thrive.

    We should not shy away from raising taxes. Evidence from international comparisons and from surveys on competitiveness suggests that reasonable levels of tax do not impede countries’ economic performance. In fact, countries which compete on the basis of low taxes do so to compensate for competitive weaknesses, such as inadequate infrastructure and poor standards of education – in other words impoverished public sectors.

    Such evidence, however, seems hard to convey to those gripped by a zeal to cut spending and taxes. Even in a “small government”/low-tax country like Australia it is possible to find areas where private funding and provision of services can displace public funding and provision.

    But such displacement is usually at high economic cost, simply to achieve an arbitrary fiscal objective. There is no point in reducing taxes if the private costs are greater than the saving in taxes, with no improvement (and in many cases a deterioration) in the services provided. We illustrate this in the case of health care funding. This is an area of significant public outlay and where, because of ongoing growth in demand, there are voices – often the voices of self-interest – calling for a shift from public to private insurance. Such a shift would be costly on all economic criteria – technical efficiency, allocative efficiency and equity.

    The rushed and secretive processes of the Commission are not the path to good public policy. There may be areas where a change in the public/private mix is justified on economic grounds, but these are not one-way towards the private sector as implied in the Commission’s brief. Because we already have a small public sector it is likely that a proper process, with research and consultation, would find a need for a net expansion of Australia’s public sector. By shutting off that possibility those who drafted the Commission’s brief are imposing a constraint which may be contrary to the community’s wishes and sound economics.

    The full submission to the Senate Select Committee can be found by going to my website. Click on ‘John Menadue Web Site’ top left of this blog page.

     

     

  • How long can we keep lying to ourselves.

    In the SMH on February 5, 2016, columnist Waleed Aly says ‘The history of asylum seeker policy in Australia will be remembered as a story of how successive governments legislated their lies to justify a world of make-believe borders and imaginary compliance.’

    See link to article below:

    http://www.smh.com.au/comment/nauru-how-long-can-we-keep-lying-to-ourselves-20160204-gml6or.html

  • John Menadue. What has happened to the 11,990 Syrian refugees?

    After telling us for months that Australia would not take additional Syrian refugees, Tony Abbott announced on September 9 last year that the government had ‘agreed to settle 12,000 Syrian refugees … one of the world’s largest (intakes) to date’. We were told that the first refugees would arrive by Christmas and the 12,000 by June 2016. State governments, community groups and churches then geared up to respond.

    But to date, after five months, only about ten Syrian refugees have arrived.

    We should contrast our performance with the generous and efficient response of the Canadians. The Canadian government website reveals that at the 31 January 2016, 15,157 Syrian refugees had landed in Canada since November 4. That number of arrivals was made up of 8,767 government-assisted refugees, 1,049 blended Visa-Office-Referred refugees and 5,341 privately sponsored refugees. By the end of January 165 Canadian communities had welcomed Syrian refugees. There had been 57 government organised flights.

    In Canada, at the 31st December 2015 there were 13,881 applications in progress, with 6,381 applications finalised but the refugees had not yet travelled to Canada.

    For this generous and efficient response the Canadians put us to shame. Why? I suggest there are several reasons.

    The first and most important reason is the political leadership and will of the new Canadian Prime Minister Justin Trudeau. What a contrast with Abbott, Morrison, Dutton and now Turnbull.

    The second is that our ‘Immigration’ Department has been changed dramatically and is no longer adequately equipped to handle a movement such as this with expedition and efficiency. Senior and experienced people with expertise in the area have left the department. The ‘settlement’ function which has been so critical for managing newcomers to Australia has been transferred out of the Department of Immigration to the Department of Social Services. Furthermore, just as our foreign policy has become securitized, so our refugee and immigration programs have been overwhelmed by border control and border protection. We even have a military style Operation Sovereign Borders. The Department is not really involved in nation-building any more. It is about border control and we saw an example of this in the Melbourne fiasco late last year. Once upon a time Australia had a well-managed ability to move people quickly who are in need of resettlement. Ministers Scott Morrison and Peter Dutton have participated in the crippling of that ability.

    The third and a more specific problem is the delay in the large backlog of cases that are waiting ASIO checking. This is despite the fact that ASIO in recent years has received a substantial increase in personnel and other resources. Checking is necessary but the fear of foreigners that has been promoted by ministers has effectively thrown the weight of effort into control rather than a humanitarian response. There are always risks in the speedy movement of large numbers of desperate people but in the past we have been able to manage that efficiently – and reasonably quickly. And the lesson of terrorism in France and elsewhere in recent months is that it is mostly young people born to earlier arrivals rather than new refugees that have turned to terrorism.

    Canada has shown us a better way to help Syrian people in great need. The Canadian Government web site puts it this way. ‘Resettling refugees is a proud and important part of Canada’s humanitarian tradition. It reflects our commitment to Canadians and demonstrates to the world that we have a shared responsibility to help people who are displaced and persecuted.’

    In Australia we also used to have that humanitarian tradition of shared responsibility to help people who are displaced and persecuted. The Coalition and the ALP are trashing our proud tradition.

    We should make amends by increasing our Syrian intake to 25 000 and really applying ourselves to the job. The Canadians have shown us the way.

     

  • John Menadue. Tax reform and vested interests.

    We are in the midst of a misleading campaign on tax and budget reform.

    Large corporations and high income groups are pressing the government to increase the GST in order to reduce company tax and taxes for high-income groups. I have seldom seen such a blatant and self-interested campaign by vested interests. And they seriously suggest that it is in the name of tax and presumably, necessary budget reform. Even Mike Baird has joined in this nonsense.

    We are told by these vested interests that the benefits of tax advantages for the powerful and wealthy will ‘trickle down’ to the rest of us, including the disadvantaged and the poor. These stories about trickle-down have been with us for years. It is claimed that the ‘trickle down’ from the wealth would encourage ‘growth’ and ‘jobs’. But there is no empirical evidence anywhere to back up this argument. Scott Morrison continues in the same vein, that if only there were more tax incentives, we would ‘work, save and invest’ more.

    See an excellent article on this issue by Ross Gittins in the SMH on February 1, entitled ‘Business-led tax “reform” won’t fly’.

     

     

     

     

     

  • John Menadue. ‘Balance’ and the ABC

    The ABC has a mistaken notion of media balance.

    It has become clear that Nick Ross, a Senior Technology Editor at the ABC, could not publish a story critical of Malcolm Turnbull’s NBN unless he also published an article critical of Labor’s NBN. To add to this bias by ABC management he was told that Labor’s plan was dead because Labor couldn’t win the next election. The ABC management was desperate to be onside with the new Coalition government.

    The ABC was making a political judgement and refused to allow a professional judgement of policies. The ABC continually ties itself in a knot over this issue.

    I recall that in the name of ‘balance’, Gough Whitlam was effectively denied access to the ABC in the 1960s. He was not allowed to appear on ABC current affairs programs unless there was a Minister to provide ‘balance’. By refusing to have a Minister appear, the ABC in effect allowed the government, to veto Gough Whitlam’s appearance. Fortunately Talbot Duckmanton, the General Manager of the ABC was persuaded that the government should not veto appearances of opposition leaders.

    We now have the ABC resuming its old veto policies, saying in effect that it will not have an article critical of Malcolm Turnbull’s NBN unless there is an article critical of Labor’s NBN.

    In the name of ‘balance’ professionalism and honesty is being forfeited.

    We have had a ludicrous so-called debate about climate change and the media’s attempt to provide balance. The media have given equal prominence to skeptics who are really a small and declining fringe. The nonsense from the skeptics has been given the same sort of coverage as the professional advice of thousands of eminent scientists around the world.

    The most grievous offender in this, of course, in Australia has been the News Ltd publications. The ABC should however re-examine what it means by ‘balance’ and the implications for its professionalism and duties to the whole Australian community.

    The ABC continues to give its former Minister and now Prime Minister an arm chair ride.

     

     

     

     

     

  • Evan Williams. Film review: ‘The Big Short’

    An opening title informs us that The Big Short is “based on a true story.” That usually means that the film we are about to see has only a tenuous connection with reality, that most of it is invented and the events depicted may not have happened at all. Is anyone suggesting that the Global Financial Crisis, the subject of this scarifying comedy from director Andy McKay, may not have happened, that the millions who lost their jobs, their homes or their businesses, or saw their families shattered by the crisis were victims of some strange delusion? Well, of course not. McKay’s film is a viciously funny and horrifically convincing account of how the GFC came into being, driven by the base instincts of crooked bankers and cynical financial go-getters.

    It’s based on a best-selling book by Michael Lewis, The Big Short: Inside the Doomsday Machine, described by Reuters newsagency as “probably the best single piece of financial journalism ever written.” McKay’s film, already a winner of many awards and a nominee for best picture Oscar, I rank as the best single film on the subject – though there haven’t been many. The last big one was J.C. Chandor’s Margin Call, set in the (well-disguised) offices of the New York investment banker Lehman Brothers, whose collapse in 2008 triggered the global crisis. In one of the more poignant moments in The Big Short, McKay gives us a desolate recreation of Lehman Brothers’ abandoned offices, a wasteland of scattered paper, idle computer screens and overturned chairs.

    So it’s funny, it’s sad and it’s scary. I remember when it first occurred to me that stock exchanges were little more than glorified casinos. But compared with those dignified bastions of financial sobriety, with their long-established rules and venerable traditions, the Wall Street financial scene (at least in the years from 2005 to 2008) was closer to a certified mad-house. And as befits a film about an outbreak of collective insanity, McKay’s film is pretty mad itself – a bundle of cinematic tricks with scarcely a moment for reflection or calm analysis. We get it all – jump cuts, freeze frames, little touches of animation, odd mixes of colour and black and white, hand-held camera stuff, and characters speaking direct to the audience as if to vouchsafe some deeper truth. But it’s never overdone, and somehow, miraculously, it works.

    McKay has assembled a top-flight Hollywood cast and given them their heads, with the result that there is much shouting and ranting and a generous scattering of four-letter words from actors of both sexes. Among the standouts are Michael Burry (Christian Bale) a retired neurologist and former Deutche Bank guru who is the first to recognise mysterious trends in the US housing market; Mark Baum (Steve Carell), a hedge-fund manager with a troubled conscience; and a barely recognisable Brad Pitt as Ben Rickert, a retired banker and one of the film’s token good guys. The cast also includes plenty of “himselfs” and “herselfs”, though I don’t think I’d heard of any of them. Margot Robbie is a real-life glamour-puss who appears in a bubble bath quaffing champagne while explaining the intricacies of the sub-prime housing market.

    It’s not important – thank goodness – that we follow what’s going on or understand what anyone is talking about. The gobbledegook of the high-end finance industry has an inscrutable charm of its own – credit default swaps, mortgage-backed securities, “ninjo” loans (mortgages issued to people with no job and no income), bespoke opportunity tranches, and my favourite, collateralised debt obligations (CDOs). There’s even something called a synthetic CDO, which I leave to your imagination. But we get the picture: when these guys talk about “shorting the AA-rated tranches of CDOs” we know they’re up to no good. Something has to give, and eventually, tragically, it does. We laugh and seethe with anger at the same time.

    It’s a compelling film – even when we have no idea what actually going on. I had the much same feeling reading Paddy Manning’s book Born to Rule, his excellent account of Malcolm Turnbull’s rise to power and prominence in the worlds of finance and politics. Of course, no one would dream of comparing our esteemed PM with the wicked wolves of Wall Street, but both in their time pursued similar intricate paths of financial wheeling and dealing, and I had little idea of what Turnbull was up to.

    In The Big Short McKay seems to be hinting at something deeper than mere financial skulduggery: his glancing references to cocaine addiction, strip joints, idiotic pop music, drug cheating in sport, and other contemporary foibles suggest that The Big Short is both a critique of market capitalism’s worst excesses and something closer to cultural decadence. Only one banker was charged in the wake of the GFC and nothing whatever was done by governments to tighten regulation in the finance industry. Yes, it could happen again. I read somewhere that Bernie Sanders, the self-proclaimed socialist candidate for the US presidency, has commended The Big Short as “excellent.” He would say that, wouldn’t he? But what does Malcolm think? Or Bill Shorten? I urge them to see it.

    The Big Short (M) is in national release in selected cinemas. Four and a half stars.

    Evan Williams has reviewed films in The Australian newspaper for 33 years. He is a Life Member of the Film Critics’ Circle of Australia for services to film criticism and the film industry.In 2015 he received the Geraldine Pascal Lifetime Achievement Award for critical writing.

     

     

     

  • John Menadue. Royal commissions – partisan politics or public interest.

    Australia has had a string of politically inspired and often useless royal commissions. The fiasco surrounding Dyson Heydon’s acceptance of an invitation to speak at a Liberal Party dinner made it even more likely that his enquiry into trade unions would be quickly discounted, except for those who wanted to pursue a political agenda against trade unions and by implication, their association with the ALP.

    In response to the Trade Union Royal Commission report, Malcolm Turnbull identified himself with business and the political ‘right’ rather than the public interest or the middle ground. He is consistently taking an ambivalent approach whether it is on climate change, coal mining, gay marriage the republic or the NBN. In response to Heydon’s report, he was not as hectoring as the Employment Minister Michaelia Cash. That is not his way with words, but in substance he followed along.. It was the same on his visit to the US. The tone was different but not the substance. We could do with ’more matter and less art’

    We have had a long list of royal commissions into trade unions. In 1976 the Fraser government had a Sweeney Royal Commission into the maritime unions. In 1982 the Fraser government received a report on bribery and corruption by the building unions. In 1984 the Costigan Royal Commission dealt with racketeering by the Ship Painters and Dockers Union. In 1989 Heydon and Meagher recommended that trade union officials should have the same fiduciary duties and responsibilities as company directors. In 2001 John Howard commissioned the Cole Royal Commission to investigate the conduct of industrial relations within the building industry.

    Despite this plethora of royal commissions, very little resulted.

    Perhaps aware of this record, Dyson Heydon in his final report decided that he had to call to his aid a former High Court Chief Justice, Sir Harry Gibbs. In his report, Heydon said

    ‘Sir Harry Gibbs was universally admired for probity. Near the end of his long life, much of which had been devoted to controversies about the meaning of the constitution, he concluded that it did not matter much for the health of the nation what the constitution meant, so long as one condition was satisfied. That was the inherent decency of the Australian people continued.’

    Mystified as anyone would be by this comment about Sir Harry Gibbs. Richard Ackland in the Australian Guardian commented

    ‘The relevance is mystifying as is the decision to propel Sir Harry (Bill) Gibbs onto the field of battle in this context. Gibbs, while a judge in Queensland, conducted a royal commission into allegations that the National Hotel in Brisbane was the centre of a call-girl operation sanctioned by the Queensland Police. After ruling heaps of available information as inadmissible and accepting an amount of perjured testimony, he could find no evidence of police corruption. This finding was so disastrous that it is credited with empowering the rotten apples in the Queensland police for another 23 years – until the Fitzgerald Royal Commission came along. Why on earth would Heydon launch his trade union report by citing a conservative judge whose name is the kiss of death in the pantheon of royal commissions?’

    Tony Abbott established a royal commission headed by Mr. Hanger on the Home Insulation Program, or pink batts as it was better known. In his report Hanger criticized the commonwealth government for having relied on the states to implement their own occupation and health laws, their own employment training programs and their own building regulations. He said

    ‘To rely on the states and territories to police their own respective workplace health and safety laws seems to have been misguided.’

    What a remarkable thing to say! As even the most ignorant would know, the states have clear responsibility in these areas which they jealously guard. To say nothing of the responsibility of employers. Yet Hanger decided to try and pin responsibility on the commonwealth government and let the states and employers go free. For a political beat-up that is hard to better. It is not surprising that we have heard little further about the first of Tony Abbott’s royal commissions into the previous Labor government’s administration. But it gave Tony Abbott and News Ltd an opportunity to attack.

    Then we had Dyson Heydon on Julia Gillard. In his interim report, Heydon said that Ms Gillard’s ‘intense degree of preparation, her familiarity with the materials, her acuteness [and] her powerful instinct for self preservation made it difficult to judge her credibility.’ In the same vein as Mr Hanger’s report on pink batts this was also an amazing thing to say. Was Heydon really saying that Julia Gillard was too smart for him? Would he have preferred her to be unprepared and ignorant about the material on which she was questioned?

    And despite the royal commission grilling over several days and the media frenzy, Bill Shorten got home free.

    The royal commission into trade unions and the Liberal Party favour corporate style regulation of the unions. They fail to acknowledge that corporations exist to advance the profits of shareholders and in this they get enormous advantages through ‘limited liability’. But trade unions are community organisations established to protect the rights of workers in a marketplace that is heavily biased against them. Union activity in Australia has been largely decriminalized since the 19th Century. Unionists should be penalized for taking action for personal gain but they should not be penalized for acting in the course of an industrial dispute to support their members.

    This royal commission into trade unions was designed to weaken trade unions. Yet trade unions have been a continuing feature of Australian political, economic and social life that protects vulnerable people in the workplace. When asked in 2014 what Australia had done right to defend the economy against chronic inequality that had occurred in the US, Nobel Prize winning economist, Joseph Stiglitz said ‘unions’. Republican presidents and business interests have bitterly attacked the role of trade unions in the US. That is one reason why there is now so much alarming inequality in that country.

    It is not surprising that there are strong unions in our maritime, construction and mining industries. Dangerous workplaces will inevitably produce strong unions to ensure workplace safety. Tough work produces tough union leaders. Every ten days there is a workforce death in the construction industry. It is dangerous work. In his cossetted world does the royal commissioner really understand how dangerous construction work can be?

    The royal commissions on pink batts and trade unions have been politically partisan. There are other areas of major concern that would have been a more appropriate focus for royal commissions and transparency. Why did almost 600 of our major corporations pay no tax in 2013-14? That included such companies as Transfield, News Group and Exxon. People damaged by conflicted advice from financial planners in our banks were refused a royal commission. There has been systemic exploitation of workers by such companies as 7-Eleven and labor hire companies. But again, no royal commissions in these far more serious areas. And the one royal commission that we should have had above all others was a royal commission on the flimsy and manipulated information that led us into the Iraq War and tragedy for millions of people, a tragedy that is still unfolding.

    The HSU and the CFMEU are fair game, but the big end of town that funds the Liberal Party is left to run free.

    There is certainly no room in Australia for unionists that are ‘louts, thugs, bullies, thieves, perjurers …. ‘as the royal commissioner described some of them. Laws should be exercised or stronger laws introduced to address these problems. But why be so partisan and allow really big offenders to go scott free just because they are closely aligned to the Liberal Party.

    At the urging of the big end of town who want him to intervene on the side of capital to the detriment of labour, will Malcolm Turnbull over-reach on industrial relations as John Howard did on Work Choices?

  • Another face of the refugee crisis.

    What beautiful photos of refugees – our sisters and brothers, our children and grandchildren!

     

    http://www.huffingtonpost.com.au/entry/frederic-seguin-refugee-photos_us_56a1439ce4b0d8cc10993c79?ir=World§ion=australia

  • Niall McLaren. A case for ‘armed neutrality’

    In its short history, Australia has been among the most aggressive nations on earth, regularly engaging in wars that, on any objective basis, have nothing to do with us. These military adventures cost us dearly in men, material and credibility without ever showing the slightest evidence that they improve our security. Malcolm Fraser argued that we graft ourselves to foreign military powers in the hope that they will come to our aid in an emergency but that this has never benefited us. At present, our military is fully enmeshed with the American war machine at all levels, to the extent that Australian officers serve in command posts in US sectors. However, there is no reason to believe that the US would ever go against its interests in order to rush to our defence.

    Most scenarios envisage that, in future conflicts, our most likely enemies would be either Indonesia or China. Bearing in mind that, by its control of the Strait of Malacca, Indonesia has us and the huge economies of North Asia in a stranglehold, picking a fight with them seems the height of folly, especially as everything says the US would not endanger its relationship with Indonesia in order to help us. China is now our biggest market and supplier so squabbling with them would take especial folly. But there is another problem to bear in mind: with the looming Trans-Pacific Partnership, Australia’s industrial capacity will be further downgraded. Very soon, we will be unable to manufacture any of the most basic requirements for fighting any sort of war. That is, we will be rendered essentially defenceless. I don’t believe this is in our interest.

    My case is that we should immediately begin to move to the defence stance known as “armed neutrality,” meaning we would build our defence capacity to the point where we would be “too prickly” to attack but would have very limited offensive capacity. There is very little reason to believe our northern hemisphere “allies” would be happy with this, because at present, they have the best of all possible worlds. We don’t, and it could easily get very much worse, meaning we would be on our own.

    Niall (Jock) McLaren is a psychiatrist with extensive experience in remote area, military and post-traumatic psychiatry. His politics and interests are humanist, rationalist, socialist and poking fun at the self-righteous.

  • Bob Kinnaird. Turnbull Government buries the FTA bad news

    The Turnbull government has proved just as determined as the Abbott government to hide from the Australian community the truth about what their FTA deals mean for the 457 visa and other temporary work visa programs.

    Under the Turnbull administration, the conclusion of Trans-Pacific Partnership (TPP) negotiations was announced on 6 October 2015 and the TPP text released on 5 November 2015. The China FTA (ChAFTA) entered into force on 20 December 2015.

    In both cases, the Turnbull government has treated the Australian community like the proverbial ‘Mushroom Club’.

    The TPP

    Three months after releasing the TPP text, no Turnbull government Minister has yet admitted publicly that it has once again negotiated away Australia’s sovereign right to regulate key temporary visa programs in crucial areas.

    Australia has committed not to apply labour market testing (LMT) or caps (quotas) in the entire 457 visa program to all citizens of Canada, Peru, Mexico, Malaysia, Brunei and Vietnam; or to all foreign nationals who are employees of businesses in Canada, Peru and Mexico who transfer to an Australian branch of that business (‘intra-corporate transferees’).

    On top of that, Australia has also made a standing offer to do the same for the three other TPP countries without a total 457 LMT exemption (the USA, Peru and Singapore) if they provide access to limited categories of ‘Australian business persons’ down the track.

    The ChAFTA concession not to apply LMT to ‘installers and servicers’ of machinery and equipment on 400 visas has also been extended to eight TPP countries – Brunei Darussalam , Chile, Japan, New Zealand, Peru, Canada, Malaysia and Mexico.

    The only public admission of Australia’s real TPP commitments on what FTA-jargon calls ‘the Movement of Natural Persons’ (or MNP) was extracted from an official of the Department of Trade in Senate Estimates by Labor Senator Penny Wong in October 2015.

    Ms Elizabeth Ward, First Assistant Secretary, Office of Trade Negotiations in DFAT had this exchange confirming LMT ‘waivers’ for various categories of persons from several TPP countries:

    Ms Ward: In this particular agreement what we have done is provide MNP on a category-by-category reciprocity basis. If parties offered to us, then we offered to them. Many of them already have had LMT waived as a result of previous FTAs. The additional LMT waivers, as a result of the TPP, are intra-corporate transferees for Canada, Peru and Mexico and contractual service suppliers for Canada, Peru, Mexico, Malaysia, Brunei and Vietnam.

    Senator WONG: We reserved policy space for LMT in the Malaysia free trade agreement. Has that been removed by the TPP?

    Ms Ward: That has.

    Ms Ward was not asked why the DFAT TPP ‘Fact Sheet’ failed to mention that Australia had committed to ‘waive’ LMT in 457 visa program and the 400 visa program for the various TPP countries.

    The best that DFAT could do was: ‘Australia’s TPP commitments are consistent with Australia’s existing immigration and workplace relations frameworks and the approach taken in other free trade agreements’.

    Apparently the drafting instruction was ‘Don’t mention we’re removing 457 labour market testing’ after the bruising ChAFTA experience.

    ChAFTA

    The main effect of Australia’s ChAFTA obligations on the 457 visa is that from 20 December 2015, Australia has given up the right to apply labour market testing or quotas in the standard 457 visa program to all Chinese citizens or nationals; and to all foreign nationals who are employees of businesses in China and transferring to an Australian branch of that business (‘intra-corporate transferees’).

    There was no official announcement of this important change by Trade Minister Robb, Immigration Minister Dutton or any Turnbull government Minister when ChAFTA entered into force.

    This was despite Trade Minister Robb putting out two media releases (on 9 and 20 December 2015) announcing that ChAFTA would enter into force on 20 December. Both neglected to mention the 457 visa program changes in the list of claimed ChAFTA ‘benefits’.

    On Friday 18 December 2015, the Immigration department quietly updated its 457 visa website to incorporate the ChAFTA 457 obligations described above, with a link to the relevant legislative instrument. Neither the Immigration Minister nor his department made any public announcement of the update.

    The Immigration Minister also had nothing to say publicly on 4 December 2015 when he signed the formal legislative instrument listing the categories of ‘natural persons’ for which ‘the imposition of labour market testing would be inconsistent with international trade obligations of Australia arising under the China-Australia Free Trade Agreement’. This ‘Determination’ is the only regulatory change needed to implement all of Australia’s temporary work visa obligations under ChAFTA.

    The instrument was simply posted on the Comlaw website along with all others made that day.

    The Turnbull government’s silence on ChAFTA and the 457 visa program follows the same pattern set by the Abbott administration. When the Korea and Japan FTAs entered into force in 2014, there was no public announcement that they removed 457 LMT for all ‘citizens/nationals/permanent residents of Korea’ and ‘citizens/nationals of Japan’; and for all foreign employees of businesses in Korea and Japan transferring to an Australian branch.

    The Immigration 457 website was simply updated, with a link to the relevant legislative instruments.

    In fact, the department’s email advice to Registered Migration Agents on the removal of 457 LMT in the Korea and Japan FTAs even warned that ‘this information is not for external distribution or publication’!

    Apparently the Immigration department wanted migration agents to play their part in keeping the Australian public in the dark about how these FTAs removed labour market testing from the 457 program – or, more likely, their Ministers did.

    The Department also told Senate Estimates in December 2015 that it would communicate any impact of ChAFTA to ‘relevant stakeholders’ – which apparently does not include the general Australian community.

    Conclusion

    The Federal Labor Opposition, having voted for ChAFTA in the Parliament, is not likely to draw attention to the Turnbull government’s efforts to hide the truth about ChAFTA, other FTAs and the 457 visa program either.

    The irony is that it is only because of Labor’s 457 reforms to the Migration Act in 2013 that the Australian community has faintest chance of knowing anything about the impact of FTA obligations on the 457 visa program.

    Labor’s June 2013 457 amendments provide for the Immigration Minister to make a publicly-available legislative instrument setting out the categories of persons in FTAs and other international trade agreements for which ‘the imposition of labour market testing would be inconsistent with international trade obligations of Australia’ (s.140GBA of the Migration Act 1958).

    As a result, the Immigration department must now also publish information on its website and elsewhere about the precise 457 LMT exemptions due to Australia’s international trade obligations, as determined by the government of the day.

    Before Labor’s 2013 amendments, Ministers and bureaucrats had no legal obligation to disclose this information, did not voluntarily disclose it and obfuscated when asked.

    Labor’s decision to support ChAFTA means it is now less likely to hold the Turnbull government to account when it fails in its duty to inform the Australian community about what proposed FTA obligations mean for the 457 and other temporary visa programs.

     

    Bob Kinnaird is Research Associate with The Australian Population Research Institute and was National Research Director CFMEU National Office 2009-14.

     

     

     

  • John Menadue. Australia Day doing well, but could do better.

    The following repost is from Australia Day 2014.

    I wonder what indigenous people thought when they saw Captain Phillip with his ships come uninvited and sail up Sydney Harbour in January 1788. There does not seem any doubt that despite their concerns they were less hostile than we are to boat people 226 years later.

    Succeeding generations came by boat in their millions, including my ancestors who came from agriculturally depressed Cornwall in SS Northumberland to desolate Port Willunga in SA in 1847. Migration has never stopped. It has dramatically changed Australia, mainly for the better.  I don’t think any country has done it as well. It has brought vibrancy and greater openness If I could be more precise, I think Australia has benefited most from refugees.  Whilst the first generation of refugees may often lack skills and education, they more than make up for it in enterprise, courage and risk-taking.  That enterprise and high aspirations are often expressed through their children who often outperform others in education.  Refugees are by definition risk-takers who will abandon all for a new life.  They select themselves much better than a migration officer can ever select them.

    We have seen the benefits of migration refugees and multiculturalism, but seem hesitant about new people.  But this hesitancy and sometimes hostility to newcomers, in time gives way to acceptance and pride in our common achievements.  This has been our experience with waves of newcomers.  Irish Catholics were initially depicted as different and perhaps disloyal.  We were prejudiced against Jewish newcomers.  German migrants, particularly in the Barossa Valley, were harassed for decades. We were sceptical of balts, reffos and dagos We were initially wary about the Indo-Chinese and what damage they might cause to the Australian way of life.  But over time, it changed.  Even the early Afghans who built the transport links in Central Australia now have a train, the Ghan, named in their honour.

    Whilst Australians are invariably hesitant about newcomers, what gives me confidence is our pragmatic acceptance.  That seeming contradictory response is shown consistently in opinion polling and over long periods.  We are favourably impressed with the personal experience we have of the neighbour or shopkeeper who is Italian, Chinese or Vietnamese.  Is there something in the casualness and our easy-going acceptance that overcomes ideological and philosophical opposition?  We eschew the extremes and don’t get too excited by ideologies at either end of the spectrum.  If November 11, 1975, couldn’t even provoke a general strike, what could?  Insurrection is rare.  There isn’t much blood on the wattle.  We bump into each other, but we don’t cause a great deal of hurt

    One important reason for our successful integration of newcomers has been our settlement programs, particularly English language training. Unfortunately the Abbott Government has now taken these settlement services out of the Department of Immigration which is now focussed on border protection rather than settlement and nation building.

    As the host, Australia has particular responsibility to provide opportunities for newcomers. But it is not a one way street. The leadership of the new communities also carries responsibilities. Most have provided that leadership. Some have obviously failed both their own communities but also the wider Australian community. There is a lesson to be learned here.

    I believe that we do not place sufficient emphasis on citizenship, not in the jingoistic way of the United States but as a symbol of our unity. There must be strong commitment to Australia and new comers must place that ahead of loyalties to former homelands. Australian residents or citizens who go to fight in wars in their former homelands must be dealt with very firmly.

    We welcome diversity but not for its own sake. Diversity must be of benefit to the common good. For example we fought too long and hard for the separation of church and state to be prepared to give way to sharia law. We have built a superstructure of enriching diversity. But that diversity has been built on a strong substructure of shared institutions and values…our constitution, the rule of law, parliamentary democracy, freedom of speech and religion, English as the national language and tolerance and equal opportunity.

    In addition to time healing differences, we have also had leaders who have inspired the best in each of us or ‘touched the better angels of our nature’ (Abraham Lincoln).  Ben Chifley overcame public opposition in allowing Jewish refugees after World War II.  Robert Menzies, on coming to office, continued the acceptance of the displaced people of Europe.  Harold Holt skilfully, but in defiance of public opinion, commenced the dismantling of White Australia.  John Gorton and Gough Whitlam continued the process.  When Malcolm Fraser responded to the anguish of the Indo-Chinese people, he knew that he was acting contrary to public opinion.  Bill Hayden and then Bob Hawke supported him.  Yet no-one today would argue that these leaders got it wrong.  We applaud their courage and leadership. John Howard and Tony Abbott were the first post war leaders to break from that bi partisan tradition and engender fear of newcomers.

    Border protection is clearly necessary to maintain public confidence in migration and refugee intakes.  But it is possible to do that, as Malcolm Fraser showed without dividing the country and punishing the most vulnerable people on earth.

    What gives me confidence, is the Australian people.  I know of a Jewish refugee boy who went to school in inner Melbourne after World War II.  He told me his story.  His sister and he were called before the headmaster. As they were leaving his office, the headmaster asked them whose photo it was on the wall.  They didn’t know, but surmised that it might be head of the police or the head of the military.  The headmaster told them who it was, but the name meant nothing to them.  They then asked their schoolmates and were told it was Don Bradman.  That Jewish man said to me recently ‘I knew then that we were safe’.  If the most important public figure for the headmaster was a famous sportsman, there was little to fear and a lot to be looked forward to in Australia.

    Our nation will always be dynamic .It will be work in progress. The Australia of today is vastly different to the Australia of my childhood with its widespread racism and sectarianism. It was socially suffocating. For those changes I am very grateful. There is a lot that we can be proud of.  No country has integrated newcomers as well as we have. But there have been failures and remedial action yet to be taken. We are yet to be reconciled to our indigenous brothers and sisters who watched the European boat arrivals in 1788. We are yet to take our share of responsibility for the displaced and persecuted people of the world.

    Fear holds us back from expressing the generosity we all possess.

  • Brad Chilcott. I donated a kidney to my son. Don’t tell me not to make it ‘political’.

    In early December, I went into surgery to give my eight-year-old son Harrison my left kidney. He heard me groaning in recovery as the anaesthetist put him to sleep a few hours later so that he could receive it. The operation was the first of my life and Harrison’s 13th. He’d experience his 14th general anaesthetic two weeks later when surgeons removed the vascular catheter that had been used to connect the dialysis machine into his heart three times a week for the five months leading up to the transplant.

    After a successful surgery, Harrison had a number of complications that meant an eight-day stay in the intensive care unit of the Women’s and Children’s Hospital in Adelaide, followed by another six days in the surgical ward. Daily blood tests, a Christmas Day virus that precipitated an extra five days of hospital hospitality, and then on Sunday, 3 January, our family enjoyed our first hospital-free day in well over a month.

    As is my wont, I covered the process extensively via my social media outlets, interspersed with the occasional comment on the social and political issues of the period – a Myefo update committed to balancing the budget on the backs of the poor here and abroad; welcoming refugees and asylum seekers; supporting my brilliant friend Wawira Njiru’s work in Kenya making sure kids don’t have to go to school on an empty stomach; protecting penalty rates from being cut by people wealthy enough not to be forced to rely on them.

    On Christmas Day, before the infection set in that evening, I took Harrison into hospital for an 8am blood test wearing the full Santa suit I’d donned to give our three children their presents early that morning. I figured if we had to be in hospital on such a day, we should at least make it memorable. We handed out candy canes to taxi drivers waiting at the rank outside, orderlies cleaning the halls and other families having a similar experience to our own. Driving home, I filled the car with petrol in full costume while commuters took photos and small children gawked in confusion. Harrison loved every moment.

    On Christmas Day, before the infection set in that evening, I took Harrison into hospital for an 8am blood test wearing the full Santa suit. That afternoon, resting after a hearty Christmas lunch with the in-laws, I posted on social media: “Trip to hospital – saw Drs, nurses, cleaners, servo staff, RAA and more helping folks enjoy Christmas. Of course they deserve penalty rates” to which one person responded, “Enough politics for the day”.

    It’s easy to understand the sentiment – why sully the joy of Christmas with “politics” when there’s backyard cricket to play and pudding to consume? But if you’re any kind of activist or political advocate, it’s a familiar response.

    Children spending their third Christmas in immigration prisons; Australian Aid set at the lowest level in Australia’s history; health and education budgets being slashed by billions of dollars; one in three Australian pensioners living below the poverty line; climate change; sexism; racism; recognition of Australia’s Indigenous people … the easiest way to avoid thinking too deeply about any issue that arises around the barbecue on the beach is to dismiss it as “politics”.

    This is nothing new – people have always employed the word “politics” in the work of absolving themselves of personal responsibility for addressing inequality, injustice and the exploitation of the earth and its people.

    For our family, however, there’s no amount of using the word “politics” that can distance us from the truth that government-funded healthcare has not only kept Harrison alive for eight-and-a-half years but has also enabled him to thrive despite a range of other physical challenges.

    He’s required a huge volume of medical supplies and medication that have been provided free of charge or heavily subsidised; publicly-funded in-school support services have allowed him to keep up with his peers educationally; 14 operations and more-than-regular appointments with physicians since birth would’ve attracted a financial cost I can’t even comprehend, entirely borne by the public purse.

    So, while it might be easy to dismiss $15bn of cuts to the annual health budget as “politics” when you read it as a headline in the paper, the reality is that those are dollars that may have been spent on a child like Harrison. Forcing people to pay for pap smears and other preventative procedures is either “politics” or it’s a change that will mean some people won’t have their illness diagnosed early or accurately enough with huge impact on them and their families.

    Similarly, cuts to the education budget and the cancellation of the Gonski funding model are either an ideological minefield to be avoided in polite conversation – or it’s $196m that won’t be spent in my electorate alone on making sure that every Australia child receives a quality education . It’s either “politics” or it’s some children missing out on the opportunity to achieve their full potential because of the economic circumstance of the family they were born into.

    For the nurses, service station staff, cleaners and other workers that helped millions of Australians, including Harrison and I, have a good Christmas, penalty rates can’t be dismissed as mere “politics”. They’re students, single parents, new Australians and more who rely on every dollar to make ends meet.

    Children in immigration prisons, women enduring the violence of men, pensioners below the poverty line, parents who can’t afford child care, Muslim Australians being vilified by politicians and abused in our streets, Aboriginal people being forced from their communities – while others treat their experiences as abstract, impersonal political concepts, these people have no such convenience. That which is derided as a topic that should not interrupt the Christmas cheer invades their lives without their consent.

    Harrison and I went back in to hospital last week for blood tests. He’s on a huge amount of anti-rejection medication. We’re in the hands of the best medical practitioners in the field, the nursing and other support staff at the hospital are wonderful and Harrison has all the social scaffolding he needs to thrive. But this situation didn’t happen by chance – throughout Australia’s history progressive people fought for this outcome, so successfully that it would be culturally unacceptable for us to be paying for this level of care. Australians naturally assume it’s what sick children deserve.

    We are living, and grateful, beneficiaries of those who valued other people enough to make politics personal.

    Brad Chilcott is the Founder of Welcome to Australia. This article was first published in The Guardian on 16 January 2016.

  • The Frontier Wars

    The following extract ‘The Frontier War’ was part of an address I gave in September 2013 for the launch of the Catholic Social Justice Statement. It was carried on this blog at the time. It was one of many blogs I have posted concerning the Frontier War and also the Maori Wars. Our military association with New Zealand did not begin in 1915 at Gallipoli. It began when we sent ships and troops to fight against the Maori people in New Zealand in the mid 19th Century.

    The Frontier War

    We have still not properly acknowledged the great damage we have done to our indigenous people. Along with the Australian War Memorial, we still blot out the Frontier War that settlers and the settler parliaments conducted right across our country from 1790 to early last century to dispossess indigenous people. There are no monuments to this long war but even the AWM concedes that 2500 settlers and police died in the war alongside 20,000 aborigines who were “believed to have been killed chiefly by mounted police.”  Informed and engaged scholars like Henry Reynolds in The Forgotten War now believe that the number of indigenous men, women and children killed was probably over 30,000. This was an epic war. Its purpose was the occupation and sovereignty over one of the great land masses of the world. It was to wrest control from a people who had lived here for 40,000 years. This was a war which was much more central to our future than any other war in which we fought. In proportion to our population in the 19th Century which was about 2 to 2.5 million people, this Frontier War was the most destructive of human life in our history. The A W M applauds indigenous people when they fought for the empire, but refuses to suitably acknowledge the 30,000 indigenous people that were killed resisting the empire that was taking their land. The AWM remembers the Sudan War of 1885 in which no Australians were killed in combat but ignores the Frontier War. We easily call to mind “Lest we forget” but it is really “best we forget” the 30,000 Australians who were killed in our Frontier War.

    The “whispering in our hearts” will continue until we are honest about our history, both its glory and its shame. Political slogans about a “black armband view of our history” are designed to avoid the truth and encourage us to forget.

  • John Menadue. Supporting Adam Goodes.

    This blog is a repost from 1 August 2015.

    Adam Goodes has been bullied and vilified because he has reminded us of our dark history and the discrimination that continues against him and many others in Australia today. We don’t like being reminded of the dispossession, killing, poisoning and discrimination against our own indigenous people. We want to forget that 30,000 indigenous people were killed in the Frontier Wars by police and white settlers. Yet we have scarcely a memorial to the 30,000 who died defending their land. The Australian War Memorial turns its back on the Frontier Wars yet with the Australian Government is spending $700 million on the centenary of WW1.

    Why can’t indigenous people behave with respect and go quietly? Why don’t they appreciate what has been done for them? Why can’t they ‘behave well like white persons’ as the CEO of Collingwood Football club said some years ago?

    Adam Goodes is proud of his history and so he should be. But that confronts many people. Their power and prejudice is being challenged.

    He said “If you say nothing or do nothing, nothing changes”. That statement makes Adam Goodes different and the focus of attacks. So many of us don’t want to change and acknowledge our own history. Adam Goodes has clearly shown that he will not “cop shit”.

    He is criticised for what is seen as a war dance, although not carrying any weapons. But we almost all enjoy and respect the Haka and what it means for all New Zealanders, Maoris and non-Maoris. In the struggle between indigenous and non-indigenous people it was Captains Cook and Phillip who introduced guns. Our own society is becoming increasingly militarised and at numerous public occasions, including Anzac, weapons are always on display.

    Adam Goodes is confronting us all and it is good that he does so, even though he is paying a heavy price. In a 2008 essay, he spoke of “being the object of racism so many times that you lose count”. .

    We are all nervous to some degree about the foreigner, the outsider and the person who is different, whether it be on the basis of race, ethnicity, religion or even gender. It is foolish to deny that there is racism in Australia – and indeed in each one of us. It is part of our DNA. But a part of us is also generous, open and tolerant. Theologian call it the struggle between good and evil.

    Differences can be unsettling but we can come to value them as they challenge us to think again about the way we are thinking and acting. Adam Goodes is challenging us to be more generous and accepting of difference in the human family.

    In the struggle between the darker and better angels of our nature as Abraham Lincoln called it, leadership is essential. Community and political leadership is critical to keep our prejudices under control and to encourage our better spirits of tolerance and generosity. The statement by over 150 community groups in the last couple of days focuses on just this issue. It calls on us all “to stop empowering the worst elements of human nature”. It features in the SMH poster for this weekend. We do respond to good ethical and moral leadership. And we have seen that in the last week from leaders such as Mike Baird and Jay Weatherill. That leadership has come from state capitals but not from Canberra.

    We badly need more leadership from our sporting leaders and fortunately we are seeing encouraging signs of it to push aside the comments of people like Shane Warne and Eddie McGuire. It is an old tactic to blame the victim.

    Many years ago, our footballers were working Monday to Friday in ‘other jobs’ with football on Saturday. Now many of them are well-paid professionals, like celebrities. They could stop the booing if they decided to stop work and stop playing like good unionists until the booing stops. That would show the solidarity we need from sports people today. The booers must be confronted and not allowed to hide in the crowd.

    I think that former Sydney Swans player Michael O’Loughlin, explained it all very well in the last week. ‘We won’t sit in silence, we will continue to fight for our mob. We will continue to be proud of who we are, what we stand for and what we are fighting for. We live in a great country and we want it to thrive and get better and better. In doing so you have to recognise what has happened in the past to indigenous people and what they continue to go through. For us to move forward as a great country those are the things we need to keep fighting for.’ I don’t think it could have been said better.

    Out of this current orgy of bullying, racism and prejudice we will hopefully become more honest with ourselves and build a more co-operative and tolerant society. The days look black at the moment but we may find in the years ahead that Adam Goodes has done this country another service, even at great cost to himself.

  • Stan Grant. The Australian Dream!

     

  • Anand Kulkarni, Travers McLeod. Battle of ideas on innovation.

    We’re now in a race to the top on innovation. Better late than never.

    Liberating ideas could reboot Australia’s economy, as we argued a year ago.

    Now it seems there are more ideas about how to generate ideas than ever before in Australian policymaking. Both the Liberal-National government (“Welcome to the Ideas Boom” and the National Innovation and Science Agenda) and Labor opposition (“Powering Innovation” and “Getting Australia Started”) have put down markers around innovation in the lead-up to this year’s federal election.

    The Coalition and Labor pronouncements have much in common:

    • growing awareness that our innovation future lies beyond national boundaries – for example, “launching” and “landing pads” linked to innovation hubs abroad, connecting the Aussie diaspora overseas, and new visas for entrepreneurs;
    • support for science, technology, engineering and mathematics (STEM) studies, which includes reducing gender disparities;
    • facilitating access to finance for start-ups and innovative enterprises through tax breaks and the like;
    • enhancing digital capabilities, which includes teaching kids to code;
    • fostering greater collaboration, especially between industry and research bodies;
    • new bodies to oversee innovation, science and technology: Innovate Australia (Labor) and Innovation and Science Australia (Coalition); and
    • action on government procurement.

    A common goal, but key policy differences

    Yet within this apparent new spirit of bipartisanship are some key differences. Some are subtle, others are not so. That is before one starts haggling over whose purse is bigger than the other’s.

    The Turnbull government’s package is pitched further down the value chain, notwithstanding measures to promote STEM studies. It presumes a core capability in the economy: the assumption is that what’s missing is the key to unlock and leverage this capability. Coalition policy includes, for example, reforming Australian Research Council linkage projects and connecting industry to innovation infrastructure.

    Labor seeks to build foundational capabilities from the ground up. It puts more emphasis on teaching computer coding in schools, preparing small to medium-sized enterprises to access government procurement, developing a national digital workforce plan and incentives for graduates to start businesses.

    Interestingly, in a political role reversal, the Coalition’s plan has more of a selective orientation by technology and institution. This is reflected in the Biomedical Translation Fund, the Cyber-security Growth Centre and the CSIRO Innovation Fund.

    Labor is more about generic capabilities across the board. This distinction, however, is not black and white.

    Labor emphasises the innovation ecosystems view of the world. It plans to create regional hubs, with university-based accelerators at the core of this approach, and a national entrepreneurship support network. It speaks of an Innovation Investment Partnership to bring together venture capital, superannuation funds and start-up stakeholders to promote new business.

    A distinguishing feature of the government’s package is its emphasis on an innovation culture. Reforming insolvency laws to reduce the stigma of failure is its centrepiece.

    Also noteworthy is a revised approach to measuring research impact. That includes engagement with industry metrics. This is in the spirit of breaking out of research silos.

    Both parties have a “challenges program”.

    The Coalition has nominated five national policy and service delivery challenges. Businesses are invited to submit proposals to address them, with winning ideas to receive grants. The most successful could be accelerated to prototype or proof of concept.

    Labor’s approach is more grassroots-oriented, like in the US. It proposes a portal for government agencies to propose challenges for the public to respond to.

    What more can be done?

    There is strength in diversity and much to commend in both plans. Yet more could be done in the following areas:

    • explicitly linking domestic challenges to corresponding global problems, thereby positioning Australia as a “solutions hub” and a leader in scaleable open-source projects and the internationalisation of ideas;
    • promoting community-driven innovation – greater intergovernmental co-ordination could scale up local solutions to local problems to a regional or national level where appropriate;
    • stronger emphasis on spreading knowledge through the economy, with university “impact” measurement expanded beyond excessive reliance on books and journals, or even commercialisation;
    • a “beyond STEM” approach to innovation, recognising the interdependencies of scientific research and non-research forms of innovation such as design and organisational systems, together with the social sciences’ pivotal role in driving prosperity within innovation ecosystems;
    • defining a stronger role for particular agents and locations – not least cities, women and girls – in the process and outcomes of innovation; and
    • a stronger ”lifecycle” view of innovation and entrepreneurship, going beyond the traditional emphasis on start-ups to include later growth stages in a seamless approach to innovation and wealth creation.

    We need a transforming, global vision

    Finally, to be credible, innovation policymaking must be located within a long-term vision of the structure of the Australian economy we should aspire to. It also demands honesty about the scale of the transformation required.

    So the glass is half-full and rising. There are international precedents more like pints than pots.

    China’s innovation hub, Chengdu, has partnered with European Union companies and organisations to share innovations among small and medium businesses and universities. The US has launched next-generation manufacturing hubs. Even one of the world’s oldest universities, Oxford, wants to be more agile in developing and translating ideas conceived in the dreaming spires.

    Ideas have started to travel the world over. Australia has barely reached base camp in the race to the top.

    Still, it’s encouraging to see Australian policy proposals breaking free of archaic and stifling debates about protectionism and picking winners. The world of ideas knows no boundaries.

    Anand Kulkarni is Senior Manager, Planning & Research, RMIT University. Travers McLeod is Honary Fellow in the School of Social and Political Sciences, University of Melbourne. This article first appeared in The Conversation on 18 January 2016.

  • Robin Room and Michael Livingston. Alcohol companies target the 20% of Australians who drink 75% of the alcohol.

    Researchers have known for a long time that alcohol consumption is quite concentrated in a small part of the population. They argue about the exact distribution, but there is substantial agreement that, so long as alcohol sales are not heavily restricted, consumption is distributed in a quite predictable way. That is, there are many light and moderate consumers, along with a long tail of those drinking at heavier levels.

    In Australia, the top 20% of the drinking-age population in 2013 consumed around three-quarters of all the alcohol consumed. The top 5% consumed more than a third.

    The concentration of alcohol consumption among the heaviest drinkers has actually increased in recent years. The top 10% of consumers accounted for 49% of the consumption in 2001, and this had increased to 53% in 2013.

    The heaviest-drinking 20% of the population reported consuming a daily average equivalent to 43 grams of pure alcohol – a bit over four standard drinks. This is a substantial underestimate of their actual drinking.

    The total amount of drinking reported in such surveys is calculated to be about 55% of the alcohol sold in Australia, so their actual daily average is likely to be about 7.8 drinks. This is nearly four times the low-risk limit of two standard drinks per day recommended by the National Health and Medical Research Council.

    The dangers of alcohol

    If you drink enough alcohol, you get intoxicated, making you unfit for a lot of everyday activities. This includes, for instance, driving a car, most kinds of work or looking after children. Apart from these issues of injury and social functioning, alcohol also carries longer-term health risks.

    At an average of four drinks per day, the chances of dying of an alcohol-related cancer or other chronic disease are two in 100 for men and 2.5 in 100 for women. At 7.8 drinks a day, the chances are about five in 100 for men and eight in 100 for women.

    Adding in risks of dying from alcohol-related injuries more than doubles the risk for men, and increases the risk for women by more than 50%. Just considering the risks of health and injury harms, alcohol is by far the riskiest commodity that a majority of us regularly consume.

    The current guidelines “to reduce health risks from drinking alcohol” set upper limits calculated on lifetime death risks from drinking. These are around four times the rate National Road Safety Strategy aims for as an upper limit of lifetime rate of deaths from traffic collisions. They contrast, for instance, with the National Health and Medical Research Council (NHMRC) guidelines on water safety, which aim to keep the risk of death from contaminated drinking water below one in a million.

    Alcohol marketing

    Those in the business of selling alcohol have long known about the skewed distribution of alcohol consumption in the population. In meetings among people in the industry, those at the top end of the distribution are called the “super consumers“, and they are vital to maintaining or increasing sales.

    If all the “super consumers” reduced their drinking to the two-drinks-a-day average recommended by the NHMRC as an upper limit, it has been calculated, based on self-reported consumption, that alcohol sales would fall by 39%.

    In its public face, the alcohol industry takes the line that it is only seeking to protect and promote “responsible drinking”: how to “drink properly”, minimising risks of harm.

    But, in its internal discussions of the need for retailers to “identify and target super consumers”, the industry is acknowledging a large part of its sales are to drinkers who are taking substantial risks with their own lives and the lives of those around them. If all drinkers in Australia were to drink within the government guidelines for low-risk drinking, the alcohol market would shrink substantially.

    If governments want to reduce alcohol-related harms, they can’t rely on the industry’s commitment to responsible drinking. It’s directly against the industry’s interests for the heaviest drinkers (who make up the majority of their sales) to drink less.

    Given this inherent conflict, policymakers should focus on well-evaluated policies such as reduced late-night trading hours for pubs and nightclubs and smarter taxation of alcoholic products. Most importantly, governments should be sceptical of working in partnership with an industry whose interests are diametrically opposed to public health.

    Robin Room is Professor and Director, Centre for Alcohol Policy Research, Latrobe University.  Michael Livingston is Post-Doctoral Research Fellow at the Centre for Alcohol Policy Research, Latrobe University. This article was first published in The Conversation on January 20,2016.