John Menadue

  • David M Neuhaus SJ. The Future of Christians in the Middle East. Part 2.

    Christian institutions and discourse

    In the Exhortation of Pope Benedict XVI, ‘The Church in the Middle East,’ the Pope pointed to the preeminent role of the Christian institutions in the mission of the Christians in the Middle East.

    “For many years, the Catholic Church in the Middle East has carried out her mission through a network of educational, social and charitable institutions. She has taken to heart the words of Jesus: ‘As you did it to one of the least of these my brethren, you did it to me’ (Mt 25:40). The proclamation of the Gospel has been accompanied by works of charity, since it is of the very nature of Christian charity to respond to the immediate needs of all, whatever their religion and regardless of factions or ideologies, for the sole purpose of making present on earth God’s love for humanity.[iii]”

    Hundreds of Christian institutions are spread across the face of the Middle East: schools and universities; institutes for the frail, the elderly and the handicapped; hospitals; and other institutions that offer social and educational services. Almost all of them are characterised by their devoted service to the societies in which they were established and by their openness to all: Muslim and Christian, as well as other minorities. These institutions reveal the face of a Christian presence that seeks to serve not only Christians but society at large.

    These institutions represent a very important Christian outreach beyond the hold of fear and isolation. Particularly notable are those institutions that serve almost entirely Muslim populations, showing the face of a Church that seeks to contribute to building up a society based upon conviviality and respect. In the Gaza Strip, 98% of the pupils in the Christian schools are Muslims. It is significant to note that after the Ba’athi revolutions in Iraq and in Syria, almost all the Christian institutions were nationalised, leading to the disappearance of this form of Christian presence in society. Perhaps the present catastrophe is related to this fact.

    Christian institutions, particularly schools, universities and hospitals, are often places where Christians and Muslims not only rub shoulders but where relationships are established and discourse on diversity and respect is developed. It is through these institutions that the Christians can and do leave their mark on society.

    The continued promotion of Christian institutions at the service of the entire population must go hand in hand with the development of an appropriate Christian discourse about the world in which Christians live. It is this discourse that must also distinguish the Christian as a voice for justice, peace, pardon, reconciliation and selfless love. Fear often provokes the development of a discourse that is reactive and insular, closing Christians off from their neighbours. The support and development of the Christian institutions which are at the service of all must be accompanied by the cultivation of a language spoken by Christians which opens them up to those with whom they share their daily lives. Faced with Muslim extremism, the Christian is called to discern, making distinctions between Muslim extremists and those Muslims who are friends, neighbours and compatriots, between extremism and those manipulated by the extremists. The Christian is also called to remember that Christians are no strangers to extremism, the toxic confusion of religion with political interests and the manipulation of God-talk in order to justify self-interest and greed.

    The Christian presence in the Middle East is not and will not be measured by its statistical importance but rather by the significance of its contribution to society, particularly in its service of education, health and relief work and in its language of love.

    Faith against fear

    In the face of fears that Christians will continue to suffer as the Middle East continues to be shaken by instability and chaos, the only Christian antidote is faith. Christians are named for their Master who did not promise a bed of roses. Christ said to his followers: ‘If any want to become my followers, let them deny themselves and take up their cross and follow me. For those who want to save their life will lose it, and those who lose their life for my sake, and for the sake of the gospel, will save it’ (Mark 8:34-35). These are words that have guided generations of Christians who have laid down their lives in faithful witness to the Gospel. It is perfectly understandable that many balk at these words, preferring to guarantee a better future for their children in a world that seems more secure in Europe, the United States or Australia. A Middle Eastern Christian diaspora can even be a support for those who consciously choose to stay behind as well as those who simply have no possibility to leave.

    However, those that inspire by their courage, determination and faith are the ones who, despite everything, stay in their ancestral homelands because they know that it is their vocation and mission to bear witness to Christ in the lands he knew best. These are the Christians whose sense of mission secures the future of the Church in the Middle East. They have put their hand to the plough and do not look back, nor do they flee. They do not fear nor do they accuse, they do not isolate themselves behind denominational walls, they do not remain paralysed in bitterness, but rather they look ahead, attempting to discern the way forward. Faith is the only sure way beyond fear and isolation to openness and service, seeking Christ and following him as he goes out in ever-widening circles. Faith is the deep-rooted sense that the victory has already been won in the resurrection, and that no matter what crosses are encountered on the way – extremism, hatred and rejection – the forces of death have been overcome in Christ’s Cross and life reigns supreme.

    The renewal of faith in the Middle East among sorely tired Christians surely brings about a greater sense of Christian unity, overcoming the divisions of the past. Pope Francis has pointed repeatedly to the ‘ecumenism of blood’, as he did in his discourse in front of the Holy Sepulchre in Jerusalem, flanked by Greek Orthodox Patriarch of Constantinople Bartholomew.

    “When Christians of different confessions suffer together, side by side, and assist one another with fraternal charity, there is born an ecumenism of suffering, an ecumenism of blood, which proves particularly powerful not only for those situations in which it occurs, but also, by virtue of the communion of the saints, for the whole Church as well. Those who kill, persecute Christians out of hatred, do not ask if they are Orthodox or Catholics: they are Christians. The blood of Christians is the same.[iv]”

    This renewal of faith likewise brings a commitment to dialogue with Muslims (and Jews in the Israel-Palestine arena) in a frank and honest call to mutual respect and shared labour in building up a society free from oppression, ignorance and fear. It also strengthens the demand to be equal citizens, fully enfranchised and willing to bear the same obligations.

    It is this voice of faith that is heard in the statement of the Holy Land Commission for Justice and Peace when they say:

    “We pray for all, for those who join their efforts to ours, and for those who are harming us now or even killing us. We pray that God may allow them to see the goodness He has put in the heart of each one. May God transform every human being from the depth of his or her heart, enabling them to love every human being as God does, He who is the Creator and Lover of all. Our only protection is in our Lord and like Him we offer our lives for those who persecute us as well as for those who, with us, stand in defense of love, truth and dignity.[v]”

     

    Fr David M. Neuhaus SJ serves as Latin Patriarchal Vicar within the Latin Patriarchate of Jerusalem. He is responsible for Hebrew-speaking Catholics in Israel as well as the Catholic migrant populations. He teaches Holy Scripture at the Latin Patriarchate Seminary and at the Salesian Theological Institute in Jerusalem and also lectures at Yad Ben Zvi.

    This article has been published in Études and La Civiltà Cattolica.

    [i] Latin Patriarch of Jerusalem, Michel Sabbah, ‘Pray for Peace in Jerusalem’ (1990), §51.

    [ii] Communiqué of the Catholic Ordinaries in the Holy Land and Justice and Peace Committee,‘Are Christians being persecuted in the Middle East?’ (2 April 2014).

    [iii] Pope Benedict XVI, ‘The Church in the Middle East’, (2012), §89.

    [iv] Address of Pope Francis, Church of the Holy Sepulchre in Jerusalem, 25 May 2014.

    [v] ‘Are Christians being persecuted in the Middle East?’

     

     

  • David Neuhaus SJ. The future of Christians in the Middle East. Part 1.

    Christians in the Middle East must be a voice for justice, peace, pardon, reconciliation and selfless love. The fear that dominates the experience of many Christian communities can only be overcome by understanding, dialogue and faith, all of which are necessary to maintain the Christian presence in the Middle East.

    In one of his pastoral letters to the Christian faithful in the Holy Land, Latin Patriarch of Jerusalem Michel Sabbah wrote:

    “Your first duty is to be equal to the situation. However complicated or difficult it is, you should try to understand it. Take all the facts into account. Consider them objectively, calmly but courageously, and resist any temptation to fear and despair.[i]”

    Fear

    Any discussion of the situation of Christians in the Middle East today must begin with the reality of the fear that has gripped Christian communities as they watch the horrific scenes broadcast from Iraq and Syria. It is not insignificant that on 31 October 2010, a few days after the closure of the Extraordinary Synod on the Church in the Middle East, convened by Pope Benedict XVI in the Vatican, an attack on a Syrian Catholic church in Baghdad left 58 dead. The subsequent surge in acts of violence directed against various ethnic and religious minorities in different regions of the Middle East is one result of the toppling or destabilising of regimes that kept the Arab world in an iron grip for decades. In Egypt, Iraq and Syria, Christians watched in horror as the authentic and deep-rooted desires for human dignity, democracy and freedom that took shape in what became known as the ‘Arab Spring’, were transformed into a chaotic and mostly brutal struggle for power. Diverse extremists, freed from decades of forceful suppression by secular dictators, emerged from the underground into the light of day.

    Since 2010, thousands of Christians have been driven out of their homes in Iraq and Syria. Christian roots and heritage have been wiped out by hooded terrorists speaking in the name of Islam and calling for the establishment of an Islamic Caliphate in the lands that have been home to Christians since the very beginning of the Christian faith. Hundreds of thousands of Christians have left behind their homelands not only in Iraq and Syria, but also in Egypt, Palestine, Israel and elsewhere, and emigrated to the West, to the New World, to more welcoming Arab countries like Jordan and Lebanon, in the wake of the collapse of a known political order.

    Fear is linked to a term on the lips of many who observe what is happening: persecution of Christians. There is no doubt that some Christians have been killed because their Muslim extremist executors see them as infidels, polytheists or Western spies. However, as the Justice and Peace Commission of the Assembly of Catholic Ordinaries in the Holy Land pointed out:

    “In the name of truth, we must point out that Christians are not the only victims of this violence and savagery. Secular Muslims, all those defined as ‘heretic’, ‘schismatic’ or simply ‘non-conformist’ are being attacked and murdered in the prevailing chaos. In areas where Sunni extremists dominate, Shiites are being slaughtered. In areas where Shiite extremists dominate, Sunnis are being killed. Yes, the Christians are at times targeted precisely because they are Christians, having a different set of beliefs and unprotected. However they fall victim alongside many others who are suffering and dying in these times of death and destruction. They are driven from their homes alongside many others and together they become refugees, in total destitution.[ii]”

    It is also true that the term ‘persecution’, when it is used uniquely to describe Christian suffering in the contemporary Middle East, is often being manipulated within the context of a particular political agenda whose aim is to sow prejudice and hatred, setting Christians against Muslims.

    Fear of what?

    Fear is a bad teacher. In order to face fear and overcome it, it needs to be understood. Christians are a particularly vulnerable sector in the Arab world as for the most part they have consistently refused to organise themselves along denominational lines as political parties or militias. For decades (since the end of the nineteenth century), the Christians who were politically and socially motivated invested their energies in the development of Arab secular nationalism in various forms. In this project, they worked alongside similarly motivated Muslims and members of other minority communities. What came to be known as the ‘Arab awakening’ was successful as Arabs developed a sense of their identity, based upon the Arabic language, the Arab-Muslim civilisation and a vast geographical region that served as a centre for the ancient civilisations that gave the world Judaism, Christianity and Islam. In the wake of the 1948 War in Israel/Palestine, in many parts of the Arab world, the monarchic regimes were toppled by Arab nationalist revolutions. Subsequently, however, these nationalist regimes, often strongly supported by the army and the police, were transformed into dictatorships that used systems of control that brutally suffocated any opposition. Among the victims of these regimes were the members of movements that sought to strengthen Muslim identity and develop anti-Western, Islamic models of government.

    The Holy Land Justice and Peace Commission document, formerly cited, stated:

    “Christians had lived in relative security under these dictatorial regimes. They feared that, if this strong authority disappeared, chaos and extremist groups would take over, seizing power and bringing about violence and persecution. Therefore some Christians tended to defend these regimes. Instead, loyalty to their faith and concern for the good of their country, should perhaps have led them to speak out much earlier, telling the truth and calling for necessary reforms, in view of more justice and respect of human rights, standing alongside both many courageous Christians and Muslims who did speak out.”

    It seems the worst Christian nightmares have become reality as the relatively secular dictatorial regimes were challenged by political Islam. The emergence of political Islam provokes a legitimate fear on the part of Christians who, at best, would be marginalised in a political system that insists on denominational identity and defines society in denominational vocabulary. At worst, Christians have been murdered, displaced from their homes, deprived of their rights, forced to submit to extortion and humiliation.

    Fear does not know fine distinctions, however. It is essential that Christians study each current of political Islam in detail. The Islamic movements in Iraq and Syria are diverse and divided; these movements cannot be simply assimilated to the Islamic movements in Egypt and Palestine. Murder and programmatic displacement of Christians cannot be assimilated to demands that Islamic symbols be respected and prioritised; emptying Mosul and the plain of Nineveh of Christians is not the same as Muslims demanding that their daughters be allowed to wear a head covering (hijab) in Christian schools in Jerusalem. Fear must be overcome as Christians not only address directly the leaders of the diversity of currents of political Islam but also challenge them to reflect on the consequences of their ideologies and visions. In fact, some Islamic currents have begun to reflect on the challenge of denominational diversity and have begun a dialogue with Christians. Fear motivates a perception that all Muslims are partisans of one vision in which Christians have no place, but overcoming fear means seeing the diversity and complexity within the complex world of Islamic resurgence.

    Overcoming fear and isolation

    A first fruit of fear is the tendency to isolation. A visible tendency among Christians in the Middle East is to isolate themselves in their own neighbourhoods, institutions and clubs. After decades of refusing isolationist tendencies in politics, some Christians are now proposing that Christians need their own political parties. More extremist Christians are proposing a Christian identity that no longer includes the Arab component, its language and civilisation. According to this view, Christians are Arameans, Phoenicians, Copts or Chaldeans, but not Arabs.

    Overcoming fear and its offspring, isolation, must take the Christians out of their self- imposed ghettoes in order to discover all those within the larger Arab world that are similarly threatened by monolithic Islamic visions that threaten the very composition of Middle Eastern society. First and foremost, it must be recognised that the first victims of Islamic extremism are Muslims who do not agree with the vision of the extremists. More Muslims than Christians have been murdered by the extremists; more Muslims have fled in fear. Secondly, other minorities, for example Yazidis, Druze and Alawis, are at greater risk than Christians because their religious faith and practice are seen as beyond any acceptable Muslim vision of diversity. Thirdly, the various currents within political Islam are far from united by a singular vision of relations with non-Muslims, and Christians must seek out those within these currents who are willing to engage and dialogue.

    A national dialogue based upon shared visions of society and its future opens up communities to interact. The Holy Land Commission for Justice and Peace proposed in its recent document:

    “Christians and Muslims need to stand together against the new forces of extremism and destruction. All Christians and many Muslims are threatened by these forces that seek to create a society devoid of Christians and where only very few Muslims will be at home. All those who seek dignity, democracy, freedom and prosperity are under attack. We must stand together and speak out in truth and freedom (…) We, alone, can build a common future together. We have to adapt ourselves to our realities, even realities of death, and must learn together how to emerge from persecution and destruction into a new dignified life in our own countries.”

    Christians, in overcoming their fear, reawaken to a sense of solidarity with their compatriots in the broader Arab world. Whereas many are inviting them to abandon their homes and their identity in this time of crisis, church and civil leaders are inviting them to remain faithful to their homeland and national identity, and to be a leaven of hope amidst the tragic dramas of today.

    Fr David M Neuhaus SJ serves as Latin Patriarchal Vicar within the Latin Patriarchate of Jerusalem.  He is responsible for Hebrew-speaking Catholics in Israel as well as the Catholic migrant populations. He teaches Holy Scripture at the Latin Patriarchate Seminary and at the Salesian Theological Institue in Jerusalem and also lectures at Yad Ben Zvi.

    This article has been published in Etudes and La Civilta Cattolica. 

    Part 2 will be posted tomorrow.

     

  • Walter Hamilton. Ships and Boats and Please Explains

    If the main aim of building ships in Australia for the Royal Australian Navy were to keep locals in work, then the South Australian-based Australian Submarine Corporation (ASC) would be a pretty good model. It spent around $400 million on salaries last year, about half its budget. If the aim, however, is to build on time, on budget, and to obtain value for money for Australian taxpayers, ASC would be a terrible model.

    South Australian spruiker Senator Nick Xenophon and others are on the warpath against competition from Japan, ahead of the long-delayed decision on supplying the next generation of submarines for the RAN. Xenophon thinks the government-owned ASC (formerly Australian Submarine Corporation) is the ticket. He claims the ASC-built Collins-class subs are now “very good” at what they do­­––proof that local know-how is perfectly able to meet the Navy’s future requirements.

    Defence Minister David Johnston intemperately (though not unreasonably) claimed last year that ASC couldn’t be trusted to “build a canoe”––and lost his job for saying so.

    Who is right?

    ASC exists to fulfill two major defence contracts: for the 6 Collins-class submarines currently (or at least sometimes) in service and the 3 Air Warfare Destroyers (AWD) now under construction.

    The company’s performance delivering and maintaining the Collins submarines was, until recently, woeful. The final report of the Coles Inquiry into the debacle, issued last year, said there had been “remarkable progress” in several areas, with reduced breakdowns and speedier maintenance. The Navy was pleased to say now that 2, and often 3, of its 6 subs were available to put to sea at any time. If that sounds less than spectacular, consider this: there were times after the Collins-class subs came into service when none was available to defend the country.

    The first subs ASC built were too noisy to avoid detection and so prone to engine failure due, among other things, to “poor design and manufacture”, it was felt in 1999 they would never meet the standard for military operations. Retrofits and redesigns have brought the subs up to scratch, but this laborious process (“ASC is a learning organisation” says the company’s annual report) has taken 27 years of a 35-year life of project, i.e. from contract-signing to when the subs will have to be replaced. The Navy began its search for a replacement submarine several years before the Collins class started delivering on its original promises.

    Now, if ASC is, at it says, a “learning organisation”, given the experience with the Collins project, one might expect it to do a lot better with the more recent AWD project. Unfortunately it has not. The first of the destroyers was due for delivery last December. The deadline came and went unfulfilled. The project is running 3 years late (for the 3rd ship) and hundreds of millions of dollars over budget. In 2013-14 the project crawled from 70% complete to 73% complete. ASC admitted to “significant challenges” in the program. Once again, the government has had to devise a rescue plan for ASC in a bid to prevent another gap opening in the country’s defence capability. This is not the “old story” of the Collins debacle, that defenders of ASC would have us discount; it is the current state of affairs in the biggest naval project Australia has ever undertaken. Who would not wish that things were different, and we were able to sing the praises of an Australian success, but nothing is gained by hoodwinking public opinion with cheap, unsubstantiated claims of a “secret” Abbott-Abe deal to give the next submarine project to Japan.

    I am, of course, not privy to the discussions taking place, though I have written here before about the close interest shown by both Tony Abbott and the now former Defence Minister Johnston in Japan’s submarine capability and, therefore, I have no doubt that Canberra would be well disposed to such a result, if it happened. But this is a far cry from the uninformed, jingoistic claptrap that is overtaking the debate on radio talkback, etc.

    Here are some facts to consider.

    The Defence Department and the RAN began scouting for Australia’s next generation submarine in 2007 and continued the process under the Rudd-Gillard-Rudd governments.

    One of the major lessons the Navy learnt from the selection process used for the Collins contract was that an open tender proved more open to political influence and fudged specifications than to public, or even departmental, scrutiny. The term “open tender” was a misnomer. European consortiums either joined the bidding with designs for “export only” submarines they had never ordered for their own navies or with designs that required significant modifications to meet Australian requirements. This flawed process greatly contributed to the project’s chronic problems.

    Navy and Defence decided that a better approach would be to survey what capabilities existed here and overseas to actually deliver to performance specifications that, on this occasion, would be defined more precisely than they were for the Collins project. They did not want to invest in another unpredictable and costly “learning curve”. Time went by, governments came and went, and by 2014, seven years into the study program, it became apparent that, at this rate, there was a risk the Collins-class subs would be obsolete and unserviceable before a replacement could be delivered––especially if a design were chosen that required major modifications and the fitting out of a completely new manufacturing operation.

    From the beginning, the Japanese were in the periscope sights of the RAN, because of the widely held opinion in international defence circles that their non-nuclear powered submarines are second to none. They are reliable and run almost noiselessly: two key requirements. Back when the Collins project was being tendered, Japan was not in the business of exporting military technology. Once that changed the Japanese automatically became front-runners. It did not take any “secret deal” to bring this about. The Sōryū-class diesel/electric submarine is the model being assessed. A sale to Australia––which could easily involve a major component of local manufacture and maintenance––would undoubtedly be a feather in the cap for Prime Minister Shinzo Abe, a proponent of a greater Japanese defence capability, but news reports this week that Japan’s Defence Ministry was thrown into confusion by the Abbott leadership challenge were sheer hyperbole, presumably intended to bolster conspiracy theorists like Xenophon and his ilk.

    It reminds me of the way the Japanese proposal for a Multifunction Polis in the 1980s was exploited by an ignorant commentariat––until the controversy, among other things, derailed the 1990 election campaign of Andrew Peacock (who fell for the “Japanese invasion” rhetoric). If the submarine project is swept up into the maelstrom of Liberal Party politics once more, with the enthusiastic encouragement of Labor and the Greens, etc., a rational decision-making process may prove to be impossible. Better to scrap the whole project if it means building subs that arrive late and incapable to a future conflict.

    Walter Hamilton is the author of “Children of the Occupation: Japan’s Untold Story” and “Serendipity City: Australia, Japan and the Multifunction Polis”.

     

     

     

     

     

     

  • Feathers ruffled in the Department of Immigration nest.

    In the e-magazine, The Mandarin, Stephen Easton has reported that ‘highly experienced bureaucrats have vacated the Department of Immigration and Border Protection since its amalgamation with Customs began last year. … There are signs confidence in the Department is low among Immigration bureaucrats, including some of Australia’s most committed and experienced experts. Deputy secretaries Liz Cosson, Wendy Southern and Mark Cormack have all handed in their resignations. … At least two First Assistant Secretaries have also jumped ship.’ This story can be found by clicking on the link below.

    http://www.themandarin.com.au/21226-feathers-ruffled-hawks-take-immigration-nest/

  • Greece didn’t fail, but the EU’s debt moralising did.

    It is often said that if you owe the bank $1 million you have a problem.  But if you owe the bank $1 billion, the bank has a problem!  The EU has that sort of problem with Greece. Joseph Stiglitz, in a recent article (see link below) sets out the problems which the EU now faces. This article was originally published in AlterNet.   John Menadue

  • John Attia, John Duggan. Why the government would have us pay more for poorer health.

    The Coalition government has been claiming that Australia’s public health system is unsustainable since the 2014 budget. But its plans for the health system actually reflect the underlying belief that user-pays health systems are better – despite evidence to the contrary.

    Less than a year and a half into the Abbott government’s first term, we’re on our second health minister and the third iteration of some kind of plan to introduce a co-payment for seeing a doctor. Despite widespread and vocal opposition to its plans, the government remains committed to introducing this price signal into the public health system.

    Underpinning this move is the government’s commitment to a user-pays health system. But there’s now a large body of evidence showing such systems not necessarily great for the nation’s health. Here are four common ideas about market-based health systems and why they are not true.

    Myth one: market forces increase efficiency

    The administrative costs of Australia’s public health system are considerably lower than that of the private health insurance sector. So while this cost for Medicare is around 6% per year, the 2012-13 private health insurers’ annual report estimates that 15% to 18% of private health insurance premiums go towards administration.

    Both these figures are similar to those in the United States, the country with the most expensive health-care system in the world. Figures from the OECD estimate that, in 2011, the per capita health cost in the US was US$8,508 (A$10,912) per head or 17.7% of GDP, compared to Australia, where the figure was US$3,800 (A$4,875) per head or 8.9% of GDP.

    But the US figure quoted above is effectively still an underestimate. The premiums for about half the Americans who have health insurance are paid by their employer; they are essentially a business deduction underwritten by the taxpayer.

    The inefficiencies of the market-based system are also apparent when comparing costs for similar conditions. Health insurance industry figures from a 2013 report show the average total reimbursement for a private hospital appendectomy in the United States is A$17,770 (US$13,851), while the cost for the same procedure in Australia is A$5,467.

    Both the former and current Coalition health ministers – Peter Dutton and Sussan Ley – have insisted on introducing a price signal for GP visits. Gary Schafer/Alan Porritt

    Myth two: market forces increase quality

    There’s no lack of evidence showing the market forces operating par excellence in the United States offer inferior health care when compared with public health systems. OECD data comparing mortality rates in member countries between 1980 and 2005, for instance, show only Portugal has had a smaller fall in adult mortality rates than the United States.

    And although it spends the highest proportion of GDP on health internationally, the United States ranks 19th in infant mortality, 43rd in female mortality and 36th for life expectancy.

    This is not to say that US health care cannot be outstanding; it just comes at a price rendering it grossly inequitable. Consider this 2008 study of 121,092 Americans admitted to hospital with bleeding from liver cirrhosis. It found likelihood of death was significantly higher for certain groups.

    By contrast, a 2011 English study of gastric bleeding in 245,438 patients found that, once hospitalised, the risk of bleeding and mortality was independent of social class. So in England, an unemployed street sweeper with gastric bleeding faces a similar risk of death in hospital as a stockbroker. But the stockbroker would have a much better outcome in the United States.

    It’s also important to remember that more care does not necessarily equate to better quality care. The Institute of Medicine recently estimated the excessive annual cost of systemic waste in the US health-care system at US$765 billion. This is almost 30% of total health expenditures.

    Over-servicing is a big problem in private health-care systems, where profits can create a perverse incentive to treat. Indeed, they potentially create a conflict with purely medical reasons for treatment.

    A landmark 1970 analysis (not available online) comparing surgery and surgeons in the United States and in England and Wales showed that the former, with its fee-for-service system, had twice as many surgical procedures as the latter places, both of which have public health systems. A 1973 analysis found a similar doubling of discretionary surgical rates in fee-for-service Canada compared to the United Kingdom.

    Myth three: public health care is unaffordable

    A number of studies indicate that it is actually private health care that’s unaffordable. It’s estimated that almost two million people in the United States declared bankruptcy due to medical bills or conditions in 2013.

    Despite widespread and vocal opposition to its plans, the government remains committed to a price signal for GP visits.NEWZULU/PETER BOYLE

    That makes health care one of the biggest issues affecting bankruptcy in that country. Worse still, the majority of these bankruptcies were expected to affect people in the prime of their working lives, between the ages of 35 and 55.

    Worse still, the problem may be snowballing: a 2009 study found medical reasons for bankruptcies had increased from 46.2% in 2001 to 69.1% in 2007. Most medical debtors were well educated, owned homes and had middle-class occupations, and 75% had health insurance.

    Despite the Coalition government’s warnings to the contrary, health-care costs are not spiralling out of control. According to an Australian Institute of Health and Welfare report on health spending for 2012-13, growth in health expenditure was the lowest since the mid-1980s.

    In fact, the average health expenditure per person fell from A$6,447 in 2011-12 to A$6,430 in 2012-13. This puts Australia’s health spending as a proportion of gross domestic product at 9.4% in 2012, just above the OECD average of 9.2% – and much lower than the cost of the US market-based system.

    Myth four: price signals work

    Indeed, the government’s commitment to price signals is itself rather problematic. Price signals temper consumption by making people consider whether what they are about to buy is worth the cost. This makes them ill-fitted to the health-care sector, which is not an optional commodity subject to the same thinking that influences decisions to buy a television or a pizza.

    The latest evidence about co-payments comes from the introduction of the 2005 Deficit Reduction Act in the United States, which allowed states to introduce emergency department co-payments for non-urgent visits. A very recently published analysis of figures from eight states that charged a co-payment and ten states that didn’t showed no difference in annual number of emergency department admissions, visits, or inpatient days.

    Evidence to date is overwhelmingly against the privatisation of medicine. By pulling together in a public system, citizens get better value and the government gets better outcomes.

    Along with education, health is a basic pillar of a just society. It represents government investment in the country’s social capital – its people. Failing to provide these adequately and equitably will reduce Australia’s productivity, competitiveness and, in the end, the sense of social cohesion that comes from equal access and equal opportunity.

    John Attia is Professor of Medicine and Clinical Epidemiology at University of Newcastle.  John Duggan is Conjoint Professor at University of Newcastle. This article first appeared in The Conversation, 5 February 2015.

  • Rosemary Breen- Living water in Myanmar

     I listened to Rosemary Breen  from  Inverell speak at my local church about the work she is doing in Myanmar to help poor villagers get access to clean water.  She was inspiring and challenging. We all know that polluted water is a cause of dysentery, diarrhoea, infant mortality and early deaths across all age groups. Rosemary Breen decided she would do something about it. 

    If you could help financially you could greatly improve the health of many young people and reduce the death rate. My own parish contributed well over $20 000 in a Christmas appeal. As each tank costs about $US 2 000 that gift will bring clean drinking water to over 10 villages.

    Rosemary Breen gives her time freely and pays for her own travel expenses.

    Can you help?       John Menadue. 

    Rosemary tells her story below.

    I began going to Myanmar in 2004, having been asked by some sisters of an international religious community to research the possibility of their starting a community there.  Eventually this happened and I would return to stay with the sisters in Yangon and help with a teacher-training course.

    About four years ago, I worked with a young woman, Maw Maw, who was trying to get a scholarship to train in early education in the USA.  This didn’t eventuate and she finally got her training in Manila.  On her return, she told me of the great need for clean water in what is known as the Dry Zone in Central Myanmar where she was going to be living and where, eventually she hoped to open a small school .Her teacher was Saya Toe, who became the organiser of the water-tank project which grew out of this tiny seed which Maw Maw had planted in my mind and heart.

    Screen Shot 2014-11-26 at 1.58.46 pm

    I had been involved in a small way in water projects in Africa and felt strongly that clean drinking water was one of our basic rights and I had already financed the building of a water-tank in the southern part of Myanmar after a cyclone had hit that part of the country.  And so it started!

    Various friends donated generously to this project. I spoke at meetings and groups and then received a very generous donation from a Trust in the UK.  So what began as a very modest idea began to grow bigger and bigger and last January I visited the forty villages and schools which now have tanks, some 3000- 5000 gallons, depending on requirements.  The cost of each tank is about $US2000…  When I returned in December 2014, the 74th water-tank was being built, much to the delight of the villagers and the little local school.  A special joy was being accompanied by a young woman who had come to Australia as a refugee with literally nothing in the early 1980s and was sponsored by our local refugee resettlement group.  Her family has already financed four water-tanks and Hieu-Duc is already planning another fund-raiser.  What an asset to Australia and to the world are these refugees that we provide protection for.

    The building of the tanks is quite simple – there is a dedicated team which goes round the villages. This means these men now have a regular income. Guttering is put on the roofs, pipes affixed and the tank is built on site, using metal mesh, bamboo and cement.  When the monsoon rains come, the tanks quickly fill up.  The local people in the villages help by getting the gravel, stones and water.

    Their labour has been estimated at 17% of the cost.

    At my last visit, a number of school principals and village headmen came to ask if they too could have a water tank. There is still great need.  As one headman said simply, “Please help us – we are so thirsty!”  Last season there was less than usual rainfall. Some tanks were empty but for as little as $20, it was possible to hire a driver and bullock-cart to refill the tanks by making numerous journeys to a well.

    One very great need that I discovered is for a second-hand 4WD. The roads are mostly sandy tracks and often the taxis I had hired could not get through. We had to get out and walk or go by bullock-cart which tested my aged bones!

    Saya Toe has organised all this without any remuneration. He visits each village four times, to discuss the proposition and educate the people who will be responsible for the tank’s maintenance. It has been a mammoth task for him.

    Since last May, the project has come under the auspices of the Global Development Group which looks after sending receipts to donors and getting the money to Saya Toe in Myanmar which previously was quite a problem.  Another advantage is that it is now tax-deductible.

    So to date, 74 villages now have clean drinking water, thanks to donors all round Australia, in the USA and recently the UK.  I pass on to you all the gratitude of so many who have seen clean water as a luxury beyond their reach which we just take for granted.  I still get really moved seeing the school children drinking clean water and know it is thanks to so many who have been inspired to help.

     

    (Living Water Myanmar is an approved project (J812N) with Global Development Group – issuing tax deductible receipts for gifts over $2.   Donate at: www.gdg.org.au/GiveToJ812N)

     

     

    Rosemary Breen can be contacted at lrbreen@nsw.chariot.net.au

  • Rod Tiffen. Murdoch blames Credlin

    Does ‘Red Rupe” have any remaining ‘red’ beliefs? Murdoch was called ‘Red Rupe’ by his fellow Oxford students in the early 1950s.  He had a bust of Lenin on his mantle, was a member of the Labour Club and generally espoused the need for radical change.  Many thought that his stance was more posturing than any deep seated set of intellectual commitments.  Later, and especially from the time he went to live in New York in 1974, his beliefs have tended towards the far right – neo-liberal economics and hawkish foreign policies – and there is a solid, indeed simplistic, consistency to them.

    Perhaps the one trace of his youthful radicalism that survives is his republicanism.  Murdoch has always been against the British monarchy.

    This posed problems for one of his closest confidantes in Britain, Woodrow Wyatt, originally a Labour MP, who was knighted and then made a life peer by Thatcher.  Wyatt was a snobbish and bigoted influence peddler, but his three volumes of diaries make fascinating reading.  In a 1988 entry, the Queen’s new press secretary asked Wyatt how can we deal with Rupert Murdoch?  Wyatt said there was little to worry about even though Rupert was against the whole idea of monarchy.  Wyatt dissuaded the official from meeting with Murdoch on the grounds that ‘Rupert likes causing a bit of a commotion’ and to give him the impression you were worried would only make him go stronger.

    The next year at dinner with the Queen Mother, she said to him Rupert’s ‘against us, isn’t he?’  Wyatt said Murdoch liked the queen and queen mother, but it is ‘the others he doesn’t like’, and that is why he runs so many scandals.  Again in 1992, Wyatt was at a dinner with the Royal family, and again he had to assure the Queen Mother that Rupert’s mother was a ‘terrific monarchist’, that Rupert was afraid of her, and so he would ‘never launch direct attacks on the monarchy’.

    So given his anti-monarchical beliefs (and that his mother was no longer alive to inhibit their expression), it is not surprising that he was among the many to express criticism of Abbott conferring an Australian knighthood on Prince Philip.  Murdoch called it ‘a joke and embarrassment’, and added that it was ‘time to scrap all honours everywhere, including UK’.

    This was, I think, Murdoch’s first public criticism of Abbott as Prime Minister, but given that he was repeating what nearly everyone else was saying – an IPSOS poll for Fairfax Media found 74 per cent opposed and only 15 per cent supported the Duke’s knighthood – it failed to create what Wyatt would consider a ‘commotion’.

    Soon after, Murdoch created a very large commotion, however, by sending three tweets, all saying that Abbott had to replace his chief of staff Peta Credlin.  Abbott had to ‘forget fairness’; ‘leadership is about making cruel choices’; firing Credlin was ‘the only way to recover team work’.  If Abbott wouldn’t fire her, Credlin should ‘do her patriotic duty and resign’.  He opined that Credlin was a ‘good person’, and he was appealing to her ‘proven patriotism’.

    Let’s put aside Murdoch’s equating the good of the Abbott Government with patriotism, and instead ponder the curious situation of a media proprietor publicly commenting on the composition of a prime minister’s office.    According to a report by the Australian Financial Review’s Phillip Coorey, Abbott had already replaced his press office director Jane McMillan last December on Murdoch’s recommendation.  Credlin and McMillan had both worked for Howard Government Communications minister, Helen Coonan, in 2006, when she introduced legislation which did not give News Limited what it wanted, according to Crikey’s Bernard Keane.

    Laura Tingle reported that, within the government, ‘there has long been a deep unease about Peta Credlin’s role because she was seen as the centre of an obsessive and inappropriate insistence on control over everything.’

    It is ironic then the public pressure for her to resign followed Abbott’s act of unparalled prime ministerial idiocy in giving the gong to Prince Phillip.  While the main line of criticism has been Credlin’s degree of control, now she was being hounded for lack of control, for failing to protect her boss from himself.

    News Corp columnists, especially Miranda Devine, joined in the hunt, at first arguing that Abbott should show his colleagues he’s changed by sacrificing something very important to him, Credlin.  She also thought Credlin should be replaced by another News Corp columnist, former Coalition staffer, Chris Kenny, who ‘various high-level media and political figures’ had urged should be appointed.  Then in the Sunday Telegraph, Devine gave a long catalogue of Credlin’s ‘Stalinist’ behavior, and how the ‘Credlin Choke’ is strangling the business of government.

    In the short term, such public pressure from Murdoch and others makes it much harder politically for Abbott to dispense with Credlin, whom he and several of his closest colleagues credit with playing a pivotal role in their election victory.  Whatever the immediate consequences, this intermingling of personnel, of private and public comments, is unprecedented.  Where does the Liberal Party end, and News Corp begin?  We have come a long way from the Fourth Estate.

    Rod Tiffen is Emeritus Professor of Political Science in the Department of Government and International Relations at the University of Sydney.

     

     

     

     

  • Brian Johnstone. The Right to Freedom of Speech

    During his flights to Sri Lanka and the Philippines, Pope Francis spoke of the massacre of the staff of a French magazine Charlie Hebdo and others at a kosher supermarket, which killed 17 persons. The attack was in reprisal for satirical depictions of the prophet Muhammad.

    “One cannot make war [or] kill in the name of one’s own religion, that is, in the name of God,” Francis said. “To kill in the name of God is an aberration.”   But, the Pope added, freedom of speech does not imply total license to insult or offend another’s faith.  “Every religion has its dignity . . . and I cannot make fun of it.”

    Spokespersons of the Orthodox Churches have also protested against the publication of the cartoons satirising religion.  The World Russian People’s Council chaired by Orthodox Patriarch Kirill stated:  “We call on journalists worldwide to observe a moratorium on publishing caricatures offending Muslims, Christians and followers of other faiths.”  The statement continued:  “Calls to reprint them are irresponsible and unjust–a blow to millions of innocent Muslims, and a show of disrespect for an entire civilisation.”

    Some Muslims reacted strongly and even violently to the republishing of the cartoons.   Muslims are reported to have protested in Niger, Sudan, Somalia, Senegal, Mali, Mauritania, Algeria, Jordan, Pakistan and the Russian republic of Chechnya.  In Niger there were reports of three deaths in the capital, Niamey, and another five in the second city, Zinder. The BBC reported that some 45 churches were set on fire or looted, and three dead were found in churches.  About 800 Muslims gathered to protest in Lakemba in New South Wales, Australia; a spokesperson rejected the Western value of freedom of speech. The protest was peaceful.

    Not everyone agreed with Pope Francis. As Christopher Lamb reported in the Tablet, on 19 January 2015, when the British Prime Minister, David Cameron, was asked about Pope Francis’s remarks by the American television channel CBS, said: “I think in a free society, there is a right to cause offence about someone’s religion.”  He went on:

    I’m a Christian – if someone says something offensive about Jesus, I might find that offensive, but in a free society I don’t have a right to, sort of, wreak my vengeance on them. We have to accept that newspapers, magazines, can publish things that are offensive to some, as long as it’s within the law. That is what we should defend.

    The UK Catholic Herald on 19 January 2015 interpreted this as contradicting Pope Francis’s comments.  This is not completely correct; the Pope would agree with Cameron on some points, but would disagree on others.

    Cameron said it was wrong to take revenge if someone insulted your faith.  Pope Francis would agree that vengeance in such a case is morally wrong and that the one who is offended does not have a moral right to take such vengeance.  He would also accept that in some countries there is a legal right to cause offence to someone by criticising that person’s religion, in the sense that it is not prohibited by the civil law.  The Pope did not require that that there should be a law prohibiting offensive speech against some people’s religious beliefs.

    There are three issues that emerge from these reports.

    Religion as solely private?

    The first is the meaning of religion itself.  In a modern secular society a typical view of religion might be as follows.  Religion may be a good thing, but it is a purely private matter.  Religious people may form communities such as Churches, but this is a free, personal decision.  Religious faith is a personal matter and it consists of individual convictions that are the expression of religious sentiments; there is no such thing as a ‘Christian culture’ except in the most general sense. The state exists basically to enable individuals to follow their personal projects and to protect them from intrusions from others that might hinder them from this pursuit.

    A right is essentially a claim to be able to act or to speak to express one’s convictions provided one does not harm anyone else.   Because religion is considered to be largely a matter of private sentiment, people generally find it difficult to appreciate that actions and speech that offend the religion of another can cause serious harm to that person.  It is moreover presumed that democracy requires freedom of speech.  Thus, whatever harm may be caused to someone by offensive speech will be outweighed by the benefit of maintaining freedom of speech for the sake of democracy.

    For various reasons, however, society may decide to set limits to the exercise of this freedom, for example by prohibiting “hate speech.”  But where there is no law against it an individual must be presumed to be free to offend others.  Since there are no generally agreed ethical norms governing such speech, one who desires to speak offensively does not need to justify his speech by providing ethical arguments, apart from a general appeal to his ‘democratic rights.’

    For the three groups that have been mentioned, the Catholic Church as represented by Pope Francis, the Orthodox Churches as represented by Patriarch Kirill and Muslim communities in general, religion is not merely an individual matter; it requires community and exists in specific communities.   Further, religious faith is not merely a matter of individual sentiment; it is a deeply personal commitment that expressed a person’s reason for living and constitutes that person’s identity.   An offence to a person’s religion is considered to be an offence to the person himself or herself.

    Religion and the state

    This second issue is the relation between religion and the state and in particular to the law of the state.  There are complex differences between the ways these three groups, Catholic Christians, Orthodox Christian and Muslims, relate to the state.  The Catholic Church has come to recognise a separation between the two; the Orthodox Churches would appear to favor a closer form of positive collaboration; the Muslim religion in principle requires the laws of the state to embody religious teaching. Such laws are called Sharia law.

    However, it does not follow that the members of such groups would require that their religion and its beliefs and practices should be protected by the law of the country in which they reside. In Australia where there are at present over two hundred different religious traditions represented, such a law would not be practically viable. This was the view of the judge in a case brought by the then Archbishop of Melbourne, George Pell in 1998. The case concerned the exhibiting of a photograph of Christ entitled “Piss Christ” that the Archbishop claimed was “blasphemous libel.”

    Justice Harper, while he acknowledged that the image was indeed offensive to Christians, found that there was no legal basis for the court to ban it. “A plural society such as contemporary Australia operates best where the law need not bother with blasphemous libel,” said the judge.

    Ethical aspects

    The third issue is that of ethics.  Cameron would seem to presume that, if there is no law against offending the religion of members of a society, such offences are justified.  However, an act may be legally permitted and nevertheless be ethically wrong.  A person who exhibits an image or makes a statement that offends the religion of others is not justified in doing so merely because he wants to express himself.  Nor may he claim a right to the freedom to do so on this basis. Such a right to freedom must be socially justified.

    The justification of the right to freedom of speech is that it is required to enable the relatively powerless to challenge the abuse of power by the more powerful.  For example, when a government official abuses his power to grant favours to his friends, a reporter may claim the right to freedom of speech to investigate and publish the facts of the case.

    But it could happen that a journalist or publisher who has significant power abuses the right to freedom of speech by attacking another who is relatively weak since he or she has fewer financial or political resources.   The effect of such an attack could be the destruction of the other’s reputation and the reduction of the capacity of that other to function effectively in society.  I would argue that this was the case when the journalist Andrew Bolt accused several persons who are light-skinned of claiming Aboriginal identity for motives of personal gain.

    The Australian Racial Discrimination Act (1975) was later amended to include a new Section 18C which prohibits: “Offensive behaviour because of race, colour or national or ethnic origin”.  The Act states:  (1) “It is unlawful for a person to do an act, otherwise than in private, if:  (a) the act is reasonably likely, in all the circumstances, to offend, insult, humiliate or intimidate another person or a group of people; and (b) the act is done because of the race, colour or national or ethnic origin of the other person or of some or all of the people in the group.”

    It is noteworthy that the act prohibits offending, but does not include religion as one of the factors that could be the basis of the offence.  The alternative later proposed by the federal attorney general Brandis stated the following:  “3. Whether an act is reasonably likely to have the effect specified in sub-section (1)(a) is to be determined by the standards of an ordinary reasonable member of the Australian community, not by the standards of any particular group within the Australian community.”

    This means that the judgment as to whether the act is offending or not is to be made not, for example, by the Aboriginal person who experiences the offence, or by the Aboriginal community, but by the “ordinary reasonable member of the Australian community.”

    This is a clear example of imposing the judgment of the more powerful group on the relatively less powerful which is a criterion for an abuse of the right of freedom of speech.  It means that the judgment as to whether the person who experiences offence is really offended is to be made not necessarily by those who might be offended, but by any member of the community.  This criterion is discriminatory; it could include those who may well be engaged in doing the offending.

    What is to be said of the use of violence in response to an offence against religion?   It is clear that Pope Francis would not justify such violence.  The connection between religion and violence was explained some years ago by René Girard, who argued that the strong commitments and even passions that are connected to religion must be channeled in a relationship with transcendence, for example with a transcendent God. When that connection is lost or abandoned the intensity characteristic of religion can be attached to a culture, a way of life, a political system or a race.

    These become invested with absolute importance and violence can readily be justified in their defence; there are incontrovertible examples of this in the history of Christianity, as in the violent suppression of heresy, the wars of religion and the persecution of the Jews.  The history of Islam includes comparable instances.

    The key word is one invoked by Pope Francis, ‘dignity.’  Dignity implies a two-way relationship: it is impossible to preserve one’s own dignity while undermining the dignity of another.  I cannot ask another to recognise my dignity, when I am refusing to recognise the dignity of that other.  This is what one does when one offends another by mocking what he holds most dear: his religion.

     

  • War on terror leads to unusual friendships.

    Paul McGeough in the SMH of January 31 draws attention to our dubious links to Middle East countries that have appalling human rights records. Our Governor General, Sir Peter Cosgrove, having given advice to Prime Minister Abbott on a knighthood on Prince Philip decided that he need  not be in Australia for Australia Day, but went off to the funeral of the late King of Saudi Arabia. What a strange order of priorities! See link below.

    http://www.smh.com.au/world/war-on-terror-leads-to-unusual-friendships-20150128-12xntq.html

  • Europe and the Greek elections.

    The Greeks have been suffering for decades at the hands of a political and business oligarchy. Corruption and massive tax avoidance have been commonplace. It is not surprising that the Greek people rejected the mainstream parties and have thumbed their noses at the the EU, the European Central Bank and the IMF. Europe looks to be headed into new territory. Leonid Bershidsky on ‘Bloomberg View’ has an interesting take on ‘Syriza, Le Pen and the Power of Big Ideas’.  John Menadue.

    http://www.bloombergview.com/articles/2015-01-26/syriza-le-pen-and-the-power-of-big-ideas

  • US Government unveils goal to move Medicare away from fee-for-service.

    On 27/28 and 29 January 2015 I posted three articles on Health Policy Reform. One issue I discussed was the major problem of fee-for-service (FFS) as a means of remunerating doctors. Such a scheme remunerates quantity rather than quality of service.

    On 26 January, the US Health and Human Services (HHS) Secretary, Sylvia M. Burwell, outlined a major change in the way that doctors and hospitals will be remunerated in future. She said ‘HHS has set a goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality or value through alternate payment models.  … Today’s announcement would continue the shift towards paying providers for what works, whether it is something as complex as preventing or treating disease, or something as straight-forward as making sure a patient has time to ask questions’.

    See statement by Sylvia M. Burwell below. Australia is increasingly out of touch as we cling to fee-for-service style payments. We are lagging behind most developed countries with FFS and even the US which has the most expensive and inefficient health services in the world.

    Better, Smarter, Healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value

    In a meeting with nearly two dozen leaders representing consumers, insurers, providers, and business leaders, Health and Human Services Secretary Sylvia M. Burwell today announced measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they give patients.

    HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.  HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs.  This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments.

    To make these goals scalable beyond Medicare, Secretary Burwell also announced the creation of a Health Care Payment Learning and Action Network.  Through the Learning and Action Network, HHS will work with private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models into their programs.  HHS will intensify its work with states and private payers to support adoption of alternative payments models through their own aligned work, sometimes even exceeding the goals set for Medicare.  The Network will hold its first meeting in March 2015, and more details will be announced in the near future.

    “Whether you are a patient, a provider, a business, a health plan, or a taxpayer, it is in our common interest to build a health care system that delivers better care, spends health care dollars more wisely and results in healthier people.  Today’s announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health care dollars more wisely,” Secretary Burwell said. “We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement.”

    “We’re all partners in this effort focused on a shared goal. Ultimately, this is about improving the health of each person by making the best use of our resources for patient good. We’re on board, and we’re committed to changing how we pay for and deliver care to achieve better health,” Douglas E. Henley, M.D., executive vice president and chief executive officer of the American Academy of Family Physicians said.

    “Advancing a patient-centered health system requires a fundamental transformation in how we pay for and deliver care. Today’s announcement by Secretary Burwell is a major step forward in achieving that goal,” AHIP President and CEO Karen Ignagni said. “Health plans have been on the forefront of implementing payment reforms in Medicare Advantage, Medicaid Managed Care, and in the commercial marketplace. We are excited to bring these experiences and innovations to this new collaboration.”

    “Employers are increasingly taking steps to support the transition from payment based on volume to models of delivery and payment that promote value,” said Janet Marchibroda, Health Innovation Director and Executive Director of the CEO Council on Health and Innovation at the Bipartisan Policy Center. “There is considerable bipartisan support for moving away from fee for service toward alternative payment models that reward value, improve outcomes, and reduce costs. This transition requires action not only by the private sector, but also the public sector, which is why today’s announcement is significant.”

    “Today’s announcement will be remembered as a pivotal and transformative moment in making our health care system more patient- and family-centered,” said Debra L. Ness, president of the National Partnership for Women & Families. “This kind of payment reform will drive fundamental changes in how care is delivered, making the health care system more responsive to those it serves and improving care coordination and communication among patients, families and providers. It will give patients and families the information, tools and supports they need to make better decisions, use their health care dollars wisely, and improve health outcomes.”

    The Affordable Care Act created a number of new payment models that move the needle even further toward rewarding quality.  These models include ACOs, primary care medical homes, and new models of bundling payments for episodes of care.  In these alternative payment models, health care providers are accountable for the quality and cost of the care they deliver to patients. Providers have a financial incentive to coordinate care for their patients – who are therefore less likely to have duplicative or unnecessary x-rays, screenings and tests.  An ACO, for example, is a group of doctors, hospitals and health care providers that work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth. In addition, through the widespread use of health information technology, the health care data needed to track these efforts is now available.

    Many health care providers today receive a payment for each individual service, such as a physician visit, surgery, or blood test, and it does not matter whether these services help – or harm – the patient. In other words, providers are paid based on the volume of care, rather than the value of care provided to patients. Today’s announcement would continue the shift toward paying providers for what works – whether it is something as complex as preventing or treating disease, or something as straightforward as making sure a patient has time to ask questions.

    In 2011, Medicare made almost no payments to providers through alternative payment models, but today such payments represent approximately 20 percent of Medicare payments. The goals announced today represent a 50 percent increase by 2016. To put this in perspective, in 2014, Medicare fee-for-service payments were $362 billion.

    HHS has already seen promising results on cost savings with alternative payment models, with combined total program savings of $417 million to Medicare due to existing ACO programs – HHS expects these models to continue the unprecedented slowdown in health care spending.  Moreover, initiatives like the Partnership for Patients, ACOs, Quality Improvement Organizations, and others have helped reduce hospital readmissions in Medicare by nearly eight percent– translating into 150,000 fewer readmissions between January 2012 and December 2013 – and quality improvements have resulted in saving 50,000 lives and $12 billion in health spending from 2010 to 2013, according to preliminary estimates.

    To read a new Perspectives piece in the New England Journal of Medicine from Secretary Burwell:http://www.nejm.org/doi/full/10.1056/NEJMp1500445

    To read more about why this matters: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-2.html

    To read a fact sheet about the goals and Learning and Action Network:http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

    To learn more about Better Care, Smarter Spending, and Healthier People:http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26.html

    Participants in today’s meeting include:

    • Kevin Cammarata, Executive Director, Benefits, Verizon
    • Christine Cassel, President and Chief Executive Officer, National Quality Forum
    • Tony Clapsis, Vice President, Caesars Entertainment Corporation
    • Jack Cochran, Executive Director, The Permanente Federation
    • Justine Handelman, Vice President Legislative and Regulatory Policy, Blue Cross Blue Shield Association
    • Pamela French, Vice President, Compensation and Benefits, The Boeing Company
    • Richard J. Gilfillan, President and CEO, Trinity Health
    • Douglas E. Henley, Executive Vice President and Chief Executive Officer, American Academy of Family Physicians
    • Karen Ignagni, President and Chief Executive Officer, America’s Health Insurance Plans
    • Jo Ann Jenkins, Chief Executive Officer, AARP
    • Mary  Langowski, Executive Vice President for Strategy, Policy, & Market Development, CVS Health
    • Stephen J. LeBlanc, Executive Vice President, Strategy and Network Relations, Dartmouth-Hitchcock
    • Janet M. Marchibroda, Executive Director, CEO Council on Health and Innovation, Bipartisan Policy Center
    • Patricia A. Maryland, President, Healthcare Operations and Chief Operating Officer, Ascension Health
    • Richard Migliori, Executive Vice President, Medical Affairs and Chief Medical Officer, UnitedHealth Group
    • Elizabeth Mitchell, President and Chief Executive Officer, Network for Regional Healthcare Improvement
    • Debra L. Ness, President, National Partnership for Women & Families
    • Samuel R. Nussbaum, Executive Vice President, Clinical Health Policy and Chief Medical Officer, Anthem, Inc.
    • Stephen Ondra, Senior Vice President and Chief Medical Officer, Health Care Service Corporation
    • Andrew D. Racine, Senior Vice President and Chief Medical Officer, Montefiore Medical Center
    • Jaewon Ryu, Segment Vice President and President of Integrated Care Delivery, Humana Inc.
    • Fran S. Soistman, Executive Vice President, Government Services, Aetna Inc.
    • Maureen Swick, Representative, American Hospital Association
    • Robert M. Wah, President, American Medical Association

  • Nanny Endovelicus. Preventing prevention Part 2

    This is part 2 of a series on health prevention. It was initially posted in October last year.  John Menadue.

    Yesterday, in part 1, I began the task of analysing the cuts to the Commonwealth’s health budget and to the promised payments to the States and Territories in the area of prevention. Are the cuts well justified by the statistics?

    Obesity – Nutrition and Physical Inactivity

    Other than tobacco and excess alcohol consumption, the rising rates of obesity are the most concerning statistics in the area of preventable diseases. People’s diets and their levels of physical activity both contribute to obesity and overweight. By mid 2012, almost two thirds of Australians over 18 years were either overweight or obese according to the Australian Bureau of Statistics, a significant increase from a decade ago. The current combined level for obesity and overweight is 63% for adults (70% of men and 56% of women). Of children between the ages of 5 – 17, about 18% are overweight and 8% are obese; this is very bad news, but at least it isn’t worse news – these numbers for children are largely unchanged since 2007-08. Unsurprisingly, a clear pattern of socio-economic disadvantage is visible: the prevalence of obese children, for example, is four times higher in disadvantaged areas.

    Australia is now in the top league tables in the obesity stakes, still lower than the United States but we’ve been catching up fast.

    On specific metrics for exercise and nutrition, the AIHW (Australian Institute of Health and Welfare is also being abolished as a standalone statutory body by decision of the 2014 Budget with the functions to be amalgamated in a mega ‘productivity and performance’ entity) reported this year that: 92% of Australians did not eat 5 serves of vegetables per day and 52% did not eat 2 serves of fruit; and only 43% of adults were active enough to meet recommended guidelines of 150 minutes per week of walking or other moderate or vigorous activity.[1]  

    The nation has a long way to go on the obesity problem. Dutton often cites the alarming obesity statistics – but mainly as a precursor to argue for his plans to charge people more for primary care from their GP – which is of course where a lot of prevention advice is given and where lower-income people are most likely to go. Given the current minister is well aware of the problem, presumably there are major initiatives to tackle obesity. However, there is no evidence in the federal budget of anything much being done. Perhaps the government is making good on its comment that this is a matter for people’s personal responsibility.

    Other Risk Factors

    There are of course other risk factors both behavioural and biomedical – eg. high blood pressure, high cholesterol, high salt intakes – but it is in particular the key risk factors described above which drive the major increases in chronic disease.   So while not unimportant, the Commonwealth, States and Territories chose to focus their efforts and funds on the SNAP behavioural risks that could potentially be influenced in a better direction.

    Where to now?

    So, with the data under our belts, does the picture suggest less attention or a reduction in funding for prevention activity?  The answer is self-evident.  More emphasis on prevention is clearly in order.  And that is what most countries are doing – increasing considerably their attention to the difficult area of lifestyle risk factors in order to counter the significantly increasing burden of preventable chronic diseases. The head of the World Health Organization, Margaret Chan, has noted that chronic noncommunicable diseases have overtaken infectious diseases as the leading global cause of morbidity, disability, and mortality and stated that “prevention must be the cornerstone of the global response.” So what’s going on in Australia? Why this attack on lifestyle-related prevention activity.

    There are perhaps two interrelated answers.

    That the Abbott Government is proving to be highly ideological – not a feature of their campaigning before the election – is hardly a matter for debate any longer.  The extent of the ideological thrust is however a surprise to many as is the extent of the influence of the far right think tanks like the Institute of Public Affairs. The IPA had waged a highly visible campaign against nanny state prevention activities in the election lead up. During the Budget, the ideological tenor of the government was especially on display when increasing spending. More money for medical research! Terrific idea? In principle, you’d think so. But the funds are for Medical – big M – research; Dutton made clear that it’s a Medical Research Future Fund – not a Health Research Fund – which is far more likely to rule out research into, for example, factors influencing behavioural elements like fast food or alcohol consumption. Particularly ironic (depressing) – but sending the clear ideological message – the savings from killing off the COAG Preventative Health Partnership and abolishing the national Prevention Health Agency are being directed into the Medical Research Future Fund according to Budget Paper #2.

    Just as worrying, and well documented by others, is the influence of the alcohol and food industries on the government (see for example Big Food with a regional flavour – how Australia’s food lobby works). The embarrassing Fiona Nash’s behaviour in hiring a junk food lobbyist as her chief of staff was probably just the visible tip of a very large iceberg. Her hamfisted attempt to delay the website and possibly wipe out the food star labelling system – and this is a voluntary system for the industry! – created the first scandal for the then new government. Given the level of control over ministerial staff appointments out of the PM’s office, one could suppose the PM thought there was no problem with having a junk food voice so intimately involved in the food minister’s work — a supposition largely confirmed in his refusal to have his non-performing junior minister resign over the matter. (As an aside, however, his reluctance could well be compounded by that fact that there are rather few women in the ministerial club and losing one – and a Nat at that – might have been rather problematical). At least they don’t let Nash out in public very often – although her launching of the most recent phase of the national tobacco campaign from a party base that still accepts Big Tobacco funding had a number of us seriously exceeding the NHMRC alcohol guidelines for single occasion risk!!

    Where the industry influence and the ideology will take us eventually is probably not to better health outcomes. Cuts to areas like prevention, just like undermining investment in newer green technologies, do not have outcomes that are immediately visible – the negative results take some time to manifest.   Eventually, our performance or rather lack of it, in prevention will become evident in the burden of disease measures and in comparison with other countries who are diligently tackling the tough lifestyle issues. The actions of an ideological government, out-of-touch with international evidence and action on these matters, is not likely to serve Australia’s longer term interests.

    [1] Australia’s health 2014, AIHW

  • Nanny Endovelicus. Preventing prevention. Part 1

    This repost is an outstanding article on prevention that I originally posted in October last year. Part 2 will follow tomorrow.  John Menadue

     

    One of the more curious decisions of the Abbott Government in its 2014 Budget was the decision by Health Minister Peter Dutton to reduce Commonwealth expenditure on prevention.

    Funding for population health broadly is set to decline substantially – although the brunt of the cuts are for later years and the real devil is in the finer detail.

    For the Commonwealth Department of Health in Outcome 1 – Population Health, the pain in the first full Dutton year is minimal – a decrease from $167M in 2013-14 to $166M in 2014-15 – peanuts! But even in this set of numbers, there are interesting messages. Prevention includes activities that “look like” medical work, for example immunisation and cancer screening programs. These areas were largely protected.

    But prevention also includes the more difficult and contentious health promotion tasks – regulatory policy for alcohol and tobacco and food (which requires examining industry behaviours like advertising of junk foods, salt levels used in processed food, and alcohol promotions) as well as programs targeting people’s lifestyle choices in areas such as smoking, alcohol use, physical activity and eating habits. As we saw last week with Liberal Democrat Senator David Leyonhjelm’s outburst on “excessive’ smoking taxes and his right to accept Big Tobacco donations, these lifestyle messages and the regulation of these industries in the interests of population health is political by definition and is likely to be an anathema to libertarians and the hard right. The imagery reached for is that of a ‘nanny state’ – see the Institute of Public Affairs (another recipient of Big Tobacco largesse) for a detailed exposition of the position.

    It is this latter area of work that took the real Budget hit.

    Programme 1.2 of Outcome 1 (for us non-bureaucratic mortals this is the part of the budget dealing with drugs like alcohol, education against illicit drug use, and tobacco) was reduced from $224M in 2013-14 to $161M in 2014-15.   And it goes on. This area will be further reduced to $131M by 2017-18 according to the forward estimates – a decrease in nominal terms of over 40% – while some of the other population health activities actually see some modest increase in that period. The axe is being swung not only at the federal level. With the Dutton death blow to the COAG[1] Partnership on Preventative Health, some $400 million of promised funding for the State and Territory Governments’ lifestyle prevention initiatives were axed as well – programs in particular focussed on children’s physical activities, community exercise and nutrition initiatives, education about lifestyle related risks and so on.

    Is there good logic to this – why cut prevention rather than, for example, reducing funding for some of the 150 low-value medical interventions that have been identified?[2]  Had the need for work in prevention lessened?  Were the metrics now moving so clearly in the right direction that government could turn its attention (and money) elsewhere? Almost all other developed countries had also been significantly increasing their attention and expenditure on prevention in the 21st century, were they cutting back too?

    SNAP – but no crackle and pop

    In 2011, the primary driver for establishing the National Partnership on Preventative Health was the alarming increase in preventable chronic disease related to people’s lifestyles.  These lifestyle issues – in particular Smoking, poor Nutrition, Alcohol misuse and Physical inactivity – the SNAP lifestyle risk factors – already accounted for some 40% of potentially preventable hospital admissions according to the Australian National Preventive Health Agency (not just a cutback but abolished in the 2014 Budget).   The growth of lifestyle diseases worrying those watching health expenditure were primarily in diabetes, various cancers, COPD, strokes and other preventable cardiovascular system diseases.

    Let’s check how the SNAP risk factors are doing.

    Tobacco

    Tobacco reduction strategies are the star performers on a population basis – a national decrease from about 35% in 1980 to 16% in 2012.  That’s one of the lowest adult smoking rates in the world.  But with some big holes. The COAG Reform Council, whose job was to assess performance of governments against their stated targets (the Council was also abolished in the May 2014 Budget), reported on the performance of the Preventative Health Partnership in 2013 and noted that Indigenous smoking rates were much higher than those of the rest of the population – still over 40%. Also important were socio-economic factors – if you are in the lowest socio-economic demographic, you have a 25% likelihood of being a smoker as compared to a someone in a more advantaged situation. Further, the city-country divide is extraordinary.  The National Health Performance Authority (to be abolished as a standalone statutory body by decision of the 2014 Budget with the functions to be amalgamated in a mega ‘productivity and performance’ entity) reported in October 2013 that in areas such as the Grampians, smoking rates were 28% as compared to city areas such Inner West Melbourne where the rate was 8%. In general, on most of the risk factors for chronic disease, the further from the city you live, the less healthy you are likely to be![3]

    While overall population figures might suggest that smoking is largely ‘done’, what the more granular data suggest is that success has been high in higher-income higher-educated urban populations and that significant effort is needed elsewhere where rates look like statistics from 30 years ago. Some focused attention was in fact occurring, in part. A major initiative – Tackling Indigenous Smoking – spearheaded by Tom Calma – was rolling out across Australia; it has had its expansion “paused” to undergo a review of its efficiency during 2014. One note of optimism: although not quantified in terms of expenditure, the May 2014 Budget committed to continue Australia’s defence of the plain-packaging of tobacco cases brought within the WTO and bilateral trade treaty arrangements.

    Alcohol

    There’s good news and bad news on alcohol. The evidence about alcohol as a risk factor has been mounting, and it’s a Group 1 carcinogen (ie good evidence it’s harmful to humans). This led a couple of years ago to a tightening of the guidelines from the NHMRC on alcohol consumption (the NHMRC is a medical research funder – and medical research is Abbott’s favourite thing – so it wasn’t significantly cutback, planned to be amalgamated or otherwise mauled in the Budget apart from the plan to set up a duplicating bureaucracy in the new Medical Research Future Fund).

    Harmful consumption of alcohol has two forms – long-term consumption at risky levels and single occasion risky consumption (basically binge drinking).   Latest stats are that about 20% of the population continues to drink at levels risky to their long-term health – pretty well unchanged from the ABS results in 2007-08; half of males and one-third of females drank riskily for single occasion risk. These are quite high statistics at a population level. The good news is that since the 1970s, our per capita alcohol consumption has declined although it remains above the OECD average.

    By far the most concerning SNAP areas are the ones leading to the disturbing trends in obesity and overweight. Both nutrition and physical activity contribute to obesity – more on the statistics and their implications in the next blog tomorrow.

     

    ***************

    [1] Council of Australian Governments

    [2] Elshaug AG, Watt AM, Mundy T, Willis CD. Over 150 potentially low-value health care practices: an Australia study. Medical Journal of Australia, 20212; 197(10): 556-560.

    [3] Risk Factors Contributing to Chronic Disease, AIHW, 2012.

  • Brian Johnstone. The right to freedom of speech.

     

    The recent murders perpetrated in France have been rightly condemned by all people who take seriously morality and human rights. However, the accompanying discussion of the right to freedom of speech has reflected different points of view. For some the right to freedom of speech means the claim to be free to say whatever one wants to say, whether this injures the rights of others or not. This view can justify any kind of remark from adolescent attempts to shock to the inane “sledging” in which our politicians so frequently indulge. The right to freedom of speech as a right has meaning only in the context of justice.

    Does it make sense to claim, as Amanda Vanstone does, that we cannot realistically support Charlie Hebdo and not support Brandis’ contention that everyone has a right to be a bigot to express that bigotry? (The Age, Monday, January 19, 2016, p. 16). Justice would require that we construct and support the social and legal institutions that are needed to protect journalists from violent attacks. But justice does not require us to accept whatever an individual or group might want to say.   Justice clearly does not require us to accept the inflammatory rhetoric of the propagators of jihad. A bigot is defined by the Concise Oxford Dictionary as one who holds some view irrespective of reason and attaches disproportionate weight to that view. Other dictionaries add to the definition intolerance of other views. Since the bigot is by definition irrational in the views he holds, he cannot ask rational persons to listen or to take any notice of what he says. Similarly, he cannot demand that otherwise tolerant persons and communities tolerate his own intolerance; he has set himself outside the tolerant community.   The appropriate sanction for the bigot is to ignore him since he has declared himself immune to reason and to vote against him if he, or she, should seek election.

    The statement: “I disapprove of what you say, but I will defend to the death your right to say it,” has been cited frequently in connection with the recent events. The words are often attributed to Voltaire, but Voltaire did not say this. To accept this literally, would mean declaring oneself ready to defend to death the right of the jihadi to continue his rabid discourses. To better understand the right to freedom of speech it is worth recalling Voltaire’s own campaigns. A most notorious case was that of the French Protestant Jean Calas. Calas was falsely accused of murdering his son in order to prevent his converting to Catholicism. After being tortured, which included “water-boarding,” Calas was condemned by the court of Toulouse to death and tortured to death by being broken on the wheel. Voltaire took up the case and defended Calas. The verdict was eventually overturned. In 1765 Calas was posthumously exonerated of all charges. This was a genuine exercise of the right to freedom of speech on the part of Voltaire. The basis of the right to freedom of speech is an obligation in justice to use speech in defense of the violation of the rights, those of others or one’s own rights in justice. The assertion, “Everyone has a right to be a bigot,” is rightly rejected as nonsense.

    The recent gathering of European leaders in Paris was no doubt a genuine gesture of solidarity with the victims and a protest against violence. It was also a manifestation of commitment to freedom of speech. It is easy to proclaim one’s support for this freedom; but such proclamations are empty unless one uses freedom of speech on behalf of justice. For example, none of the three, France, Britain or the U.S.A., have an unblemished record on this. Both the French and the British governments have suppressed freedom of speech. The most egregious examples have been in relation to torture, which both governments and their agencies have condoned.

    The practice of torture and killing carried on by French officers in Algeria during the conflict that preceded Algerian independence was documented by the French-Algerian journalist Henry Alleg in his book La question. When the book was published French authorities banned it. The celebrated 1966 film The Battle of Algiers that depicts the torture carried out by French commanders Massu and Aussaresses was banned and shown uncensored only decades later. President Hollande has called colonial rule in Algeria “brutal and unjust” but did not apologize for its violations.

    Aussaresses taught his torture methods throughout the world. The notorious U.S. Phoenix Program in Vietnam applied the French tactics of interrogation, torture and summary execution. He also instructed the Chilean secret police under Pinochet. Unlike Aussaresses, his commander in Algeria, Massu eventually abandoned his defense of torture and urged the French government to condemn its use in Algeria. Former French soldiers admitted that the torture they practiced had produced a mass of misinformation and that the lives they may have saved were far outnumbered by those taken by the new terrorists they created.

    http://www.thedailybeast.com/articles/2013/12/04/french-torture-mastermind-paul-aussaresses.

    In 2013 the Guardian revealed that the British government was still concealing secret government files from the closing period of colonial rule. These included documents concerning the mistreatment and torture of Kenyans suffered during the Mau Mau insurgency. The foreign secretary William Hague promised that these documents would be declassified and opened to the public. Elderly Kenyans were trying to sue the British government for compensation.

    The files that were withheld are part of a cache of documents that were hidden in a secret archive of the Foreign and Commonwealth Office (FCO). This was in violation of the laws that govern the handling of official papers. Hague ordered an inquiry and promised disclosure.

    He told MPs: “I believe that it is the right thing to do for the information in these files now to be properly examined and recorded and made available to the public through the National Archives. It is my intention to release every part of every paper of interest subject only to legal exemptions.” The documents were not released. The Foreign Office held back the documents, claiming a legal exemption based on a clause within the same law that it broke by maintaining the secret archive in the first place.

    (http://www.theguardian.com/uk/2013/apr/26/national-archives-colonial-documents-secret)

    The mistreatment and torture was revealed in a book by Caroline Elkins in a book published in 2005 entitled Imperial Reckoning, the Untold Story of the British Gulag in Kenya. Eventually, in 2013 a judge compelled the Foreign Office to release its documents. The British government made an unprecedented apology and agreed on a settlement. Each surviving victim received about $4,000. Elkins reported that the official documents confirmed, in explicit detail, the accounts of victims, both male and female, that she had collected. There was “forced sodomy with broken bottles and vermin and snakes and just horrific, horrific things,” she says. “So not only was it absolutely wrenching to read these, but it was also validating on so many levels and particularly that the British government had been calling them liars,” she says, “All the while sitting on the evidence proving that they were actually telling the truth.”

    (http://www.npr.org/2013/06/09/189968998/britain-apologizes-for-colonial-era-torture-of-kenyan-rebels.)

    The U.S.A., the Senate Intelligence Committee report on CIA torture is an historically significant example of the exercise of the right to freedom of speech by a government body. A 525 page portion published on December 9th. 2014 included key findings and an executive summary. However, the rest of the document remains classified.   It will be interesting to see whether a fuller publication will ever follow. Governments have seldom been exemplary practitioners of freedom of speech.

    Voltaire would have found an appropriate pungent phrase for this kind of official behaviour regarding freedom of speech. Caroline Elkins and others like her have taught us what freedom of speech really means.

     

    Brian Johnstone is a Catholic priest who taught moral theology in Rome for nearly 20 years. Currently he teaches at the Catholic University in Washington.

     

  • Robert Douglas. Senate report on Australian inequality.

    Bridging our growing divide: Inequality in Australia is an important report tabled without fanfare in the Senate by its Community Affairs References Committee. The report is clearly argued and well-buttressed by data and references. The points it makes about an issue central to the kind of society we are developing in Australia deserve wide community discussion.

    The inquiry terms of reference called for a review of the extent of income inequality, the rate at which it is increasing and its impacts on access to health, housing, education and work.

    The senators were also asked to inquire into specific impacts on disadvantaged groups. These included the likely impact of government policies – especially 2014-15 budget measures – on rates of inequality, the principles that should underpin social security payments and practical measures that government could implement to address inequality.

    The six-month inquiry engaged 13 senators – five from the ALP, five from the Liberal Party, two Greens and one independent. The 273-page report, tabled in December 2014, drew on 64 written submissions and seven public hearings involving 59 witnesses from government and voluntary agencies around the nation.

    The report makes it clear the non-government representatives reached consensus on the key findings. The government members, led by Zed Seselja, were uncomfortable with the conclusions. They tabled a dissenting report.

    I was a co-author of a report by the Australia21/Australia Institute, Advance Australia Fair? What to do about growing inequality in Australia. This was released in mid-2014. I met the committee as a witness and spoke about the origins of the report in a roundtable of experts at Parliament House in January 2014.

    Arising from that rich discussion we proposed ten ways to move to a fairer Australia. These included promoting a national conversation about inequality, its effects and ways of dealing with it.

    The stark inequalities of Australian wealth feature on the cover of the Advance Australia Fair? report. Australia21/Australia Institute
    Click to enlarge

    What did the inquiry find?

    The committee’s majority report states that income inequality has increased in Australia since the mid-1980s. It asserts that the budget measures will be likely to exacerbate income inequality and poverty. The report emphasises that the Newstart payment is too low – for a single adult recipient it is more than A$100 per week below the poverty line.

    The report points to the important role of the minimum wage and the fact that lower incomes are associated with poorer health outcomes. In addition, low transfer payments or low incomes often compound the disadvantage felt by groups such as Aboriginal and Torres Strait Islander peoples, people with disability, people living with mental illness, single parents and new migrants.

    It also argues the need to consider how the income-support system can assist the large and growing group of people with insecure work. The report notes that regional variations in labour markets can seriously limit people’s employment opportunities.

    It goes on to underline the importance of Commonwealth rent assistance and of long waiting lists to enter public and social housing. According to the report, a decent wage is the best way to lift people out of household stress.

    Finally, the report discusses the importance of a one-on-one approach for reconnecting people with education, training and employment opportunities. It argues the need to invest in programs that connect with young people at risk of leaving school early, that develop tailored training for workers aged 50 and above and that provide long-term unemployed people with mentors.

    The report makes 13 recommendations to act on these key findings.

    The Senate report cites research that suggests the public differs from the government on the urgency of acting to reduce inequality. Australian National University, Australia Election Study 1987–2013, CC BY-NC-ND
    Click to enlarge

    What is the government position?

    The government senators’ dissenting report affirms that Australia is a prosperous egalitarian society, which provides security and opportunity for all. It argues that while Australia has some significant issues with poverty and much can be done to improve opportunity and circumstances for all Australians, the majority report adds little to the debate. It says history has shown that a strong economy that provides employment is the best way to build a prosperous society.

    The dissenting senators say arbitrary comparisons between relative income levels pale in significance compared to Australia’s capacity to grow wealth and lift people out of poverty through employment and education. The majority report fails to make the case that inequality is driving poor socioeconomic outcomes, they say, and does not meaningfully engage with budget policies to improve these outcomes.

    The five-page dissenting report has a single recommendation:

    That the Senate implements the government agenda to build a strong and prosperous economy for the benefit of all Australians.

    That this is the government members’ response to inequality in Australia shows why the public needs to join the debate.

    Robert Douglas is Emeritus Professor, National Centre for Epidemiology and Population Health at ANU. This article first appeared in The Conversation on 13 January 2015.

  • Ian Coller. Liberty, equality, fraternity: redefining ‘French’ values in the wake of Charlie Hebdo.

    Beyond the tourist fantasy of the Louvre and the Eiffel Tower, France today is a fabulously colourful mixture of Christians, Muslims, Jews, Buddhists, Hindus, atheists. This is the situation all over Europe. Yet many Europeans are deeply uneasy with this diversity.

    The names of Charlie Hebdo victims reveal the diversity hidden by the Je suis Charlie hashtag: cartoonists and writers Charb, Cabu, Wolinski; psychoanalyst Elsa Cayat; proofreader Mustapha Ourrad; policemen Franck Brinsolaro and Ahmed Merabet; two students killed in a kosher supermarket, Yoav Hattab and Yohan Cohen.

    Yet media and government often still refer to Muslims as “them”: tolerated foreigners, immigrants graciously accorded rights by the state. And Muslims often respond by considering themselves unwanted outsiders, even enemies.

    Until the Second World War, many believed that Jews could not be French. That lie was at the heart of the Dreyfus Affair that tore the country in two. Under the Nazi occupation, millions of Jews were arrested across Europe and sent to their deaths. Since the 1980s, France has come to terms with the ugly truth about its role in those deportations. When it comes to Islam, however, many Europeans still suffer from historical amnesia.

    Most French people forget that Algeria was part of France for 130 years. They are unaware that the current Republic was born out of the bitter struggle over Algerian independence. France’s colonial domination extended through Asia, Africa, the Caribbean and the Pacific, but its heart was in the Muslim lands. Algeria became an integral territory of France after the Revolution of 1848.

    In that year French men were the first to gain universal suffrage. Muslims, however, were excluded from voting for almost a century. Only after 1945 could Muslim men vote, along with French women. It took another 13 years for Muslim women to gain that basic right.

    The Fourth Republic collapsed in 1958, when settlers fighting to keep Algeria French carried out a wave of terrorist attacks across France, culminating in an attempted coup d’état. Wartime leader Charles de Gaulle was hurriedly recalled and given emergency powers.

    Against violent settler opposition, de Gaulle signed Algeria’s independence in 1962. A million European settlers, along with hundreds of thousands of Algerians, crossed the Mediterranean to France. French companies kept their lucrative interests in petroleum and mining. The two countries remained indissolubly linked.

    Yet after decolonisation, most French citizens simply erased the colonies like a bad dream. Algerians could not do the same. In the 1990s, things turned nasty after the secular, French-backed regime in Algiers annulled elections won by an Islamist party. A bloody civil war broke out, killing more than 100,000 people. For Algerians in France, this horror left trauma, distrust and anger.

    In 1995, the violence hit France when a bomb in the Paris subway left eight people dead. The atrocity ramped up French support for the authoritarian Algerian regime’s “war on terror”.

    At home, the Muslim headscarf was increasingly targeted as a dangerous symbol of defiance against French secularism. The authorities banned the hijab in public schools, and made face covering in public illegal. Women wearing facial veils could be arrested in the street, forced to undergo searches, or pay fines. Rather than promoting secular freedoms, these laws fanned extremism, and pushed Muslims further to the margins.

    A position once associated with the far-right, denouncing the loss of “French identity”, has now moved into the centre, where even elements of the former Left have joined it. The French values trumpeted by this republican fundamentalism are abstractions that have little connection to the reality of French society. Freedom of speech is one of these.

    Right-wingers and libertarians alike enthusiastically applauded Charlie Hebdo’s bravery for publishing cartoons offensive to Muslims. Yet it is not clear what they were actually meant to achieve. To insist on abstract principle over negotiation, respect and compromise is what we usually think of as fanaticism.

    Leaders of the fascist-leaning Front National (FN), eager to profit from the potential backlash, now mourn a magazine that consistently reviled them. Je suis Charlie, agreed former leader Jean-Marie Le Pen – adding that he meant Charles Martel, who expelled Muslims from France in the Middle Ages.

    The attackers, French citizens of Algerian descent, also saw things in black and white. Their Islamist beliefs were built on a violent rejection of difference, a refusal to tolerate disagreement, dissent and compromise. This virulent religious nationalism is a mirror of movements like FN that rely on fear of Islam to build their constituency.

    But all is not lost. Asked what he was thinking during the minute of silence for the victims, one man said he was staring at the words on the column before him. Liberty, Equality, Fraternity.

    These are not French values. They belong to everyone. They are not easy, nor are they unstained by violence. Heads on pikes, the guillotine, wars, revolutions: it took a century of struggle for French people to agree on these words. They were almost lost in the brutality of colonial oppression, in the dark years of the German occupation and the anti-Semitism that some French people – including, sadly, many Muslims—perpetuate even today.

    We must confront the past in its richness and its ugliness. France has never been the postcard fantasy of cheese and baguettes. There have always been Muslims, Jews and Christians in France. As one Muslim wrote during the French Revolution:

    No matter where I first drew breath, or the religion in which I was born, we are brothers.

    Many Muslims feel the same today.

    Of liberty, equality and fraternity, the last is the biggest challenge. It is not just an idea but a way of life with deep roots in the French tradition. It is equally familiar in Islam. Fraternity is more than solidarity. It asks us to engage in the difficult project of living together, not as “us” and “them”, not in black and white, but in celebration of the vibrant colour that is Europe today.

    Ian Coller is senior lecturer in History at Latrobe University. This article first appeared in The Conversation on 13 January 2015.

  • Chris Clohessy. Bad reading leads to destructive religion.

    The recent terror attacks in France have highlighted a number of issues, all needing further discussion. One is the reality that it took an attack on European soil to provoke such a reaction – 1.6 million people marching in Paris, led by forty or more world leaders. But militant groups, under Islamic guise, have been slaughtering people for an extended period of time – in Nigeria, in Pakistan, in Syria and Iraq – in the last few weeks Boko Haram terrorists have killed over two thousand in Nigeria. The world reaction, compared to its reaction to Paris, has been negligible, suggesting an inconsistency in the way we value human life.
    A second issue is whether free speech can legitimately include hate speech. The reason that I don’t walk down the street calling out racial or bigoted epithets at people of colour, or of a particular culture or religion, is because I am neither a racist nor prejudiced against people who are different, but also because such behaviour is profoundly wrong. In that sense, I quite rightly do not have complete freedom of speech: both the civil law and the moral law forbid speech that is hateful: leading one to ponder whether the now popular #jesuischarlie slogan believes that bigoted or hateful speech is a permissible part of free speech. Charlie Hebdo is an unpleasant publication: not satire, for satire is subtle and clever, but simply crude, bigoted and unfunny. Those who speak in its defence insist that religion is an idea, and that ideas can be attacked. But Muhammad, or Pope Benedict or Jesus of Nazareth are not ideas: they are people, and Charlie Hebdo attacks them brutally and regularly. In 1946 the judges at Nuremburg unanimously sentenced to death a Nazi named Julius Streicher. He had never killed anyone: but he did publish an appalling newspaper call Der Stürmer, which incited anti-Semitic feeling mostly by its cartoons caricaturing members of the Jewish faith. So, can free speech legitimately include hate speech? If not, then we don’t have freedom of speech: and who knows, maybe that’s not a bad thing after all.
    But no cartoon could ever be as offensive as the taking of a single human life: the slaughter of men, women and children, young and old, armed and unarmed, Christian, Muslim, Jewish, Yazidis and so many others in the last few months by men and women claiming to act in the name of Islam, remains the most pressing issue. It is not because these are educated Muslims living Qur’anic principles that the massacres are happening, but because they are uneducated people, Islamic only in name or in the slogans they carry, who consistently fail to read their sacred texts correctly. A sacred text cannot be read and then acted out: there is a middle step, that of authentic interpretation which, if bypassed, leads to all sorts of fundamentalisms. The issue with the Qur’an is not whether it exhorts to violence – at times it does – but whether or not those exhortations were for their time only, or whether they have a universal and timeless validity. As long as a portion of people read their text incorrectly, we will continue to experience behaviour in the name of religion which is destructive and  life-threatening.
    *Fr Chris Clohessy is Parish Priest of Newlands/Claremont in the Archdiocese of Cape Town. He is South Africa’s leading Catholic Scholar in Islamic Studies and wrote this guest column for the Jesuit Institute.

  • Wendy Sharpe – Asylum seeker portraits and stories

    The Asylum Seekers Centre is presenting an art exhibition – ‘Seeking Humanity’ – by renowned Australian artist, Wendy Sharpe. It opens in Ultimo, Sydney, on 17 February, for four weeks, before moving to Canberra on 20 March, and then Penrith.

    It is not about politics, but puts a human face to those who have fled situations of great danger in their home country in search of safety and freedom in Australia. The video has been very successful, with over 500 people viewing it within the first 24 hours.

    A previous Archibald winner and 2014 finalist, Wendy has drawn portraits of 39 asylum seekers and refugees. Through her art, she shares their lives with us to show that underneath all the troubles and politics around the issue, we are all the same. That we all have the same hopes and dreams.

    More info – http://asylumseekerscentre.org.au/seeking-humanity

  • Building more roads is not 21st century thinking.

    In my blog of 3 January, I discussed our love affair with cars and how cars are crippling our cities.

    In the SMH on January 12 this year, Jacob Saulwick takes up the issue of our failure to face up to the futility and cost of building more roads. See link below to the article. John Menadue.

     

    http://www.smh.com.au/business/building-more-roads-is-not-21st-century-thinking-20150111-12lstx.html

  • Charlie Hebdo – Freedom of expression in an imperfect society.

    In this article, Paul McGeough in the SMH says ‘Yes, it is utterly inappropriate to go round shooting those who cause offence, but is it appropriate to go round causing offence?’ Paul McGeough also recalled that when Charlie Hebdo republished the controversial Danish cartoons of the prophet Muhammad in 2006, then French President Jacques Chirac issued a swift rebuke.  ‘Anything that can hurt the convictions of someone else, in particular religious convictions, should be avoided – freedom of expression should be exercised in a spirit of responsibility’. John Menadue

    http://www.smh.com.au/world/charlie-hebdo-total-freedom-of-expression-has-little-chance-of-survival-in-an-imperfect-society-20150112-12mgih.html

  • Charlie Hebdo and Algeria.

    Robert Fisk of The Independent traces the Charlie Hebdo massacre back to the French occupation and disaster in Algeria. See link to this article below.

    http://www.independent.co.uk/voices/comment/charlie-hebdo-paris-attack-brothers-campaign-of-terror-can-be-traced-back-to-algeria-in-1954-9969184.html

  • Walter Hamilton. Crunch Time for Abenomics

    Is it time to declare Abenomics, the recession-busting strategy of Japanese Prime Minister Shinzo Abe, a failure?  If so, was the recent Japanese election purely an exercise for Shinzo Abe to protect himself and the ruling coalition from a half-awake electorate before the deluge?

    Launched with much fanfare in 2012, Abenomics promised to cure deflation, revive economic growth, break down structural rigidities in the economy, unlock the talents of women in the workplace and salvage the nation’s deficit-drowned budget. In two years, it has achieved none of these objectives; nor, arguably, has it brought any of them within reach.

    Deflation:

    After briefly ticking up to around 2% per annum––the central bank’s target––Japan’s core inflation rate has declined again to 0.7%, with some major retailers reporting a further drop in turnover during the recent end-of-year sales. One of the paradoxes of the current situation is that, despite historically loose monetary policy, money in circulation is tight. Japanese households, once famous for their high savings ratio (20%+), are now forced to dip into their savings (i.e. the nation’s domestic savings ratio has turned negative) just to keep their heads above water.

    Growth:

    Recent GDP data revealed Japan had fallen back into recession. Domestic demand remained a drag, as was––more surprisingly––private investment. The economy has contracted in six of the past 11 quarters for which official data are available. Manufacturers have lowered their expectations, according to the latest Tankan survey, the most authoritative indicator of future trends. If the GDP figure comes in positive for the final quarter of 2014, as some predict, it will be because a weaker yen has helped to boost external demand. However, with European economies going backwards, Chinese growth abating and the U.S. recovery maturing, an export-led recovery hardly seems feasible.

    Structural Rigidities:

    Structural change is harder to achieve in any economy and must be considered a medium to long-term objective. The problem is that the Abe Government has not clearly articulated what Japan’s future economy should look like. Though it has declared a willingness to join the Trans-Pacific Partnership––the regulatory and investment treaty being promoted by the United States––negotiations between Tokyo and Washington have been painfully slow. Interest groups hostile to the TPP, from the medical to the agricultural sectors, are doing their best to hold up a deal. Free trade agreements with China and South Korea remain a long way off, partly because of soured political relations.

    Lately, Abe has put more emphasis on corporate tax reform. One of the ruling coalition’s first actions after being re-elected was to approve a cut in the corporate tax rate by 2.5 percentage points to 32.1%, effective from this April. Another cut to 31.3% is due to follow a year later. The government also delayed the next scheduled consumption tax increase and unveiled a slew of other tax changes and incentives, although nothing radically new was announced. Whether these measures can stimulate demand remains doubtful, given that less than a third of Japanese corporations, according to Reuters, are actually paying tax (the rest are either unprofitable or making use of credits from earlier losses).

    Women:

    Abe says he wants more women to stay in the workforce (60% quit work when they have their first child) and be given opportunities to advance (female representation on company boards is just 1%). But he is up against a competing lobby among his conservative allies who want greater action to stem Japan’s falling birthrate. Some progress has been made­­––for instance, an expansion of childcare places––but there is a deep-seated cultural bias in the workplace against full female participation. Long hours of overtime remain the norm in companies, big and small. Studies have shown that the overtime ‘phenomenon’ has less to do with lifting productivity than with maintaining male-dominated corporate hierarchies. Anecdotally there is little evidence of change.

    Deficit:

    Government debt in Japan, equivalent to more than two years of gross domestic product, has continued to climb under the Abe administration. The fiscal 2015 budget is likely to add about 38 trillion yen (A$380 billion) to the debt. Few observers now believe the government can meet its target of balancing the primary budget (excluding debt serving commitments) by 2020. Fiscal hawks, however, are fighting a rear-guard action, and social security spending is being screwed down, further widening the gap between the ‘haves’ and ‘have-nots’ in society. With fiscal expansion apparently no longer an option, there is a growing tension within Abenomics between expansionary and contractionary policy settings.

    Upside:

    The most important, and unexpected, wind-shift in favour of Japan, in recent months, has been the collapse in the prices of oil and other natural resources. The depreciation of the yen, engineered by the central bank to help revive corporate profits and support employment, had led to a sharp increase in the prices of finished imported goods and in the input costs of businesses. Energy imports swelled Japan’s large trade deficit, especially after the Fukushima nuclear disaster, but significant relief can be expected in 2015.

    Wages:

    For some observers, the key to the success or failure of Abenomics is wages growth. Professor Hiroshi Yoshikawa of Tokyo University is one prominent economist who has argued that reversing falling wage-rates, and not monetary easing (the primary focus of Abenomics Mark I), is the way to break the deflationary spiral. Abe’s own economic advisers have derided Yoshikawa’s thesis, but it seems the more pragmatic Abe is starting to pay attention to the professor. At their annual end-of-year soiree, Japanese captains of industry were exhorted by the prime minister to use higher profits to pay higher wages this year. While pressure from the top will probably have some effect, big companies may hand out larger bonuses (which can be adjusted downwards again later) rather than increase base pay-rates.

    The year ahead:

    Having just returned from a fortnight in Japan, my impression is that conditions have not fundamentally improved. It is easy to gain a false impression, if you are a tourist who only visits the corridor between Tokyo’s Ginza and Shibuya districts, where glitzy retail outlets always seem to have well-heeled customers. But go to the outer suburbs of the capital or to provincial towns and you will find evidence of continuing economic stress: shuttered commercial streets, miserably low casual wage-rates, depopulation, and decaying infrastructure.

    Even in the trendier parts of Tokyo, businesses are struggling to attract customers. One anecdote will suffice. I took lunch at a new restaurant in Aobadai that, judging from the smart décor and linen service, could be expected to leave me $50-$75 out of pocket for my meal, if it were in Sydney or Melbourne. I selected a course that included soup, bread, salad, pasta, dessert and coffee. The food was beautifully prepared, delicious, and in generous proportions. It cost me $11. How the restaurant could pay its rent, wages and materials costs, and still make a profit, was a complete mystery.

    Japan seems to be surviving on a mysterious, mathematics-defying, leap of faith. Perhaps what we are witnessing will, in time, bear out the old adage ‘it is always darkest before the dawn’. Though I would never underestimate the capacity of the Japanese to reinvent themselves, it is hard to escape the conclusion that something just doesn’t add up.

    Journalist and author Walter Hamilton reported from Japan for eleven years for the ABC.

     

     

     

  • Corporate tax avoidance.

    The Parliamentary Library has prepared a report for the Senate inquiry into corporate tax avoidance.  The report provides background on this issue as well as a summary of what other countries are proposing to address corporate tax avoidance by multinational companies. See link to report below.  John Menadue

    http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/FlagPost/2014/December/Senate_inquiry_into_corporate_tax_avoidance

  • A taxing tale of two peak bodies.

     

    In the SMH on 2 January, Michael West drew attention to the ways that two BCAs were treated differently. The Blind Citizens Australia (BCA) learned that it had been subject to federal government funding cuts. Another BCA, the Business Council of Australia, did much better. ‘Only a week earlier the government had backflipped on a proposed tax-avoidance reform entailing some $600 million in tax deductions that multinational companies could claim on interest on their debts in offshore subsidiaries.’ For the full story from Michael West see link below.  John Mendue

    http://www.smh.com.au/business/a-taxing-tale-of-two-peak-bodies-20150101-12gcty.html

  • Max Corden. Without revenue, Australia can only have half a budget debate.

    The missing element in this week’s mid-year economic and fiscal outlook, and more broadly, in current government policy, stares Australians in the face. Revenue needs to be increased. Increasing taxes, reducing tax concessions and eliminating loopholes are all options, which I and other commentators have argued for.

    For example, journalist Peter Martin has shown that if compulsory superannuation contributions were taxed as income, i.e. like wages (rather than being taxed at a concessional rate) there would be a net gain to the budget of approximately A$12 billion a year. But there are many other measures to consider, all designed to increase revenue. Prominent is the ending of negative gearing.

    Many of these possibilities, and more, were discussed in the Henry tax review, with many more expected to be discussed in the forthcoming white paper on tax reform. But this should have been the first order of business. This is where the solution to the “budget crisis” lies. There is, indeed, no reason why there should be a crisis.

    Corporations and households all borrow – and as a result go into debt. Why can’t governments do the same? At present Australia’s federal public debt is modest (relative to GDP) compared with the debt of most comparable countries. Why then create this air of panic or, at least, guilt?

    Click to enlarge

    There are two explanations.

    The first is that the Coalition has demonised deficits. In its view Labor produced deficits for several years but it – the Coalition – will produce surpluses by some specified time. It seems they believed in the demons they created, and as a result made unwise promises. Perhaps they genuinely believe that deficits are “bad””. Some of them even thought that the deficits of 2008-9, which were produced deliberately for Keynesian reasons to avoid excessive unemployment during the global financial crisis, were dangerous.

    There is a second, more rational, explanation for being concerned about budget deficits and setting the attainment of a surplus as a target. Too much debt leads to having to pay higher interest rates and, with the accumulation of debt, a bigger burden on the budget. All this is obvious. But there is the problem of political discipline. Less discipline on spending leads to more debt. Someone who has a tendency to alcoholism is wise to stay off alcohol altogether. This is the argument from prudence. But it can be carried to extremes, as it is at present.

    It is quite surprising that in the mid-year update there is a massive concern about a budget deficit and the objective of getting to surplus, relative to a concern about the state of the economy at a time when there is excessive unemployment. Is the government’s focus sensible?

    Click to enlarge

    The blame game

    Treasurer Joe Hockey blames (1) the sharp fall in the iron ore price, (2) the Senate and (3) the adverse inheritance from the previous government. With regard to commodity prices, one can never foresee world price changes precisely, but way back in the Howard years, when the iron ore price rose so much, there were plenty of people who saw the probability – not the certainty – of a later decline, and recommended caution (Ross Garnaut was one of them).

    With regard to the cross-bench Senators, they have reflected public opinion. They simply bear out the observation that the biases of the budget, as originally presented by the Treasurer, were not in tune with Australian historical attitudes and public opinion.

    Click to enlarge

    To what extent are the policy decisions of previous governments to blame for excessive spending commitments? The Gonski education reforms and the proposed establishment of a Disability Insurance Scheme under the Gillard government can take some of the blame. Perhaps there were other (possibly irresponsible) decisions as well. But what the budget statement seems to ignore is the severe harm done by the “Howard Gift”, namely the five personal income tax reductions and superannuation concessions of the Howard Coalition government.

    The elephant in the room

    Commentators like me are sometimes accused of being “economic rationalists”. Well, this is an area where more rational thinking is needed. The GST might be broadened and increased (though Hockey seems loathe to do so). Even the carbon tax might be reinstated, since it would both help to finance the budget substantially and bring about a desirable reduction in carbon emission. Both these widely-canvassed and very rational ideas, while economically sound, would encounter political and public opposition, particularly the broadening of the GST. Bipartisanship is needed here.

    Given the missing elephant of revenue, the mid-year update can be summarised as follows: Government spending can and will be cut, but the possibility of increasing revenue is not considered. The Australian government is required to live within its means, the means being defined as ruling out measures that generate extra revenues. The aim is to minimise the size of government irrespective of the purposes and efficiencies of the various governmental activities.

    The only hopeful sign is the admirable recent decision of the government to produce its tax white paper in 2015, which presumably includes the possibility of increasing revenue – the missing element in the budget update.

    Max Corden is Professorial Fellow in the department of Economics at University of Melbourne.

    This article first appeared in ‘The Conversation’ 19 December 2014.

  • Israel must be its own worst enemy.

    The Palestinians have requested that they join the International Criminal Court. It could be a double-edged sword if both Palestinian and Israelis were brought before the International Court. But most people would believe that joining the International Court would be an important way to demonstrate that the Palestinians wanted to join the international community and be subject to its norms.

    But both Israel and the US opposed the request. Robert Fisk in The Independent on 6 January this year underscores the futility of policies in the Middle East.  See link below. John Menadue.

    http://www.independent.co.uk/voices/comment/robert-fisk-the-real-reason-why-israel-and-the-us-dont-want-palestine-to-join-the-international-criminal-court-9956751.html?utm_source=indynewsletter&utm_medium=email05012015

  • The Chinese are coming.

    After WWII the financial hegemony of the US and Europe in the IMF and International Bank was established. Later, the Japanese came to dominate the Asian Development Bank. That is now being challenged by China. See article below by William Pesek in ‘Bloomberg View’, subject ‘China steps in as world’s new bank’.  John Menadue.

    http://www.bloombergview.com/articles/2014-12-25/china-steps-in-as-worlds-new-bank

  • Mary Chiarella. Co-payments, general practice and workforce reform.

    If there’s a problem in primary health care then nurses are (and always have been) the solution. 

    Susan Sontag wrote in 1978 “Illness is the night side of life: a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and the kingdom of the sick”. I was working in palliative care nursing when I first read this and it struck me that, continuing the metaphor, nurses were therefore like tour guides for those negotiating these health care kingdoms of both the well and the sick. We provide the translator services (“what did they say nurse?”), the coordination of meetings and events (“I need an appointment to see…”); the advice on what to do and how to do it (“I don’t know how to work this spacer thing”), and always, always, always the assistance to do whatever needs to be done when people lack “the necessary strength, will or knowledge” (Henderson, 1966) to do it themselves.

    If we look to primary health care (PHC) there is clearly a need for “tour guides” in this space, whether it be to help them stay in the kingdom of the well or to assist them to travel in the kingdom of the sick. John Menadue has suggested the key is to rethink funding for general practice. I would go further. The key is to rethink who provides the bulk of PHC and then think about how to fund it.

    In 2009 I compiled a compendium of nurse-led PHC models in 38 countries for the World Health Organisation (WHO, 2009).The elements of PHC identified for reporting purposes in the template were that each service, programme or project should:

    • provide essential health care based on practical, scientifically sound and socially acceptable methods and technology;
    • be universally accessible to individuals and families;
    • involve full participation of the community;
    • have a cost that the community and country can afford to maintain;
    • foster self-reliance and self-determination;
    • be an integral part of the country’s health system and overall development; and
    • have an entry level for patients located close to the heart of the community.

    The main needs of the populations served were those of the chronically ill and the elderly, basic social and infrastructure needs, psychological and mental health needs, maternal and child health needs and acute care needs (particularly in war zones).

    To provide a local example of what is possible, the work of an Aboriginal renal nurse practitioner in Australia with both indigenous and non-indigenous groups suffering from end-stage renal disease brought about significant health gains. The need for this role was identified as a result of the rising number of people needing acute dialysis 24 hours a day. A retrospective study of the causes of this rise suggested that 80% of the patients had risk factors that, if addressed early enough, would have prevented admission to the tertiary referral hospital for acute intervention. These risk factors were further examined and the diagnostic, clinical and referral skills required to address them were evaluated, and it was found that the scope of practice of a nurse practitioner met the requirements. The community nephrology nurse practitioner was able to develop and implement nursing models that integrated evidence-based clinical management with nursing advocacy for quality of life.

    Two key areas, considered central to the success of the case studies, presented challenges for a number of contributors. These were the issues of reliable and adequate funding and resources, and challenges to narrow thinking about the capacity of staff to take on new roles. The issue of sustainable funding; access to other resources such as medication, equipment, textbooks and staff created significant challenges. Some projects were completely or predominantly funded through the charitable sector (for example Chile, Haiti, United States). For example, a US project working with a poor community in Chicago sought its primary funding from a charity, and supplemented it with grants from no less than 16 funding sources and a further 13 in-kind donation sources. The time required to undertake the fundraising, administration and reporting on so many donations takes the nurses away from much-needed care delivery.

    In addition, there were a number of reports of medical and some nursing staff having difficulty in letting go of conventional and stereotypical thinking about who ought to perform which tasks. This issue has been much studied and discussed (Chiarella 2002) and has been described in relation to affirmative action as the ‘myth of the meritocracy’ – the possibility of work being taken on by another group, unless similarly qualified, is unthinkable because they are seen as incapable of meeting the challenge (Hall 1997). Yet there is ample evidence and experience to show that different personnel and community members are capable of equal, high quality participation in health care decision-making and delivery. Strong claims to maintain the status quo are often made on the grounds of safety and quality, but the evidence about the outcomes demonstrates this resistance to change is based only on protecting professional power and privilege.

    There is such potential to harness the skills of nurses to provide first class primary health care in this country, yet currently we seem to move further and further away from this potential and back to outdated models of health care provision that service only those who can afford to pay.

    Mary Chiarella is Professor of Nursing, Sydney Nursing School, University of Sydney.

  • Maggie Callingham. Top schools ‘top’ because someone has to be bottom.

    Across Australia Year 12 students are collectively holding their breaths to see what results they’ve achieved and, consequently, what their futures hold.

    Only hours after their release, many secondary schools proudly display their best results on billboards for passers-by to see. Newspapers select high-achieving students to profile. As schools promote these glowing results, it’s worth highlighting that many have had the invisible slave of the disadvantaged schools working for them.

    That is, the high-profile academic success of some schools has occurred as a result of social stratification – the increasing gap between students into schools of low socio-educational advantage and schools of high socio-educational advantage – as well as differential funding arrangements. Around Australia, some condone these arrangements in the name of “school choice” while others condemn them in the name of “school equity”.

    School choice

    Australian states and territories each have their own version of one or more senior secondary certificates that promote pathways for their students – usually into some form of further education or the workforce. Victoria, for example, has the academic, university-oriented Victorian Certificate of Education (VCE), as well as the practical, vocationally-oriented Victorian Certificate of Applied Learning (VCAL). However, the relatively high public profile of VCE results can incline schools seeking an academic reputation to offer only VCE – and in some cases, the even more prestigious International Baccalaureate (IB).

    Schools that promote their academic orientation and excellence usually do so to attract predominantly upper or middle-class families, or those aspiring to such classes. In addition to using expensive advertising to recruit their students, many academic schools provide scholarships to entice high-achieving students away from their neighbourhood schools. The pressure on these schools to maintain reputations for strong academic scores can motivate them to focus more on grooming their star academic learners and less on affirming their applied learners, or on catering for students from disadvantaged backgrounds requiring additional support.

    In pursuing such a strategy, academic schools privilege a select group: conforming, middle-class, elite-performance students. As a result, students and families that do not fit into the compliant, middle-class, academic profile of the school may find they are overtly or covertly encouraged to seek another school. The actual wording of this encouragement may be couched in language that indicates the student needs to find a new school “to suit his or her needs”, but the subtext is clear: the school is safeguarding its academic reputation and status. The outcome for these schools is an increasingly homogenised and advantaged school community.

    School equity

    In contrast, Victorian schools that offer both VCE and VCAL pathways meet an equity principle under which VCAL was introduced in 2002, to ensure that all students are able to access a senior secondary program of study. Schools prepared to take all-comers may find themselves catering not only for bright local students who haven’t been tempted elsewhere, but also non-academic students other schools have chosen to ignore or reject.

    As a result, these schools can be perceived as less successful than their high-achieving counterparts because their outcomes are likely to be skewed toward non-university pathways such as apprenticeships, traineeships, vocational courses or employment.

    These are each valid pathways, but as the Australian government acknowledged when it looked into youth transitions in 2009, much work is required to promote vocational pathways so they are seen as equal first-choice options. Unfortunately, five years on, little has changed in Australia regarding this public perception.

    One reason disadvantaged students are more likely to choose a less academic pathway such as VCAL can be found in Australia’s national and international testing results. Both NAPLAN and PISA results reveal that the lower the social class of an Australian student, the lower his or her test scores.

    It seems reasonable, therefore, that students who have been disadvantaged from an early age, the time when they learn foundation skills such as reading and writing, will be less inclined to pursue the reading and writing-oriented VCE. It is also not surprising that VCAL might better appeal to young people from economically disadvantaged families who then seek job-related pathways as a means to gain crucial financial independence or contribute financially to their families.

    School funding

    It’s no secret that schools don’t operate under similar funding conditions. Recent researchreveals funding increases from 2010 to 2013 across the three main school sectors are inversely proportionate to the socio-educational advantage of their student populations.

    Click to enlarge

    This growing social stratification and inequitable funding between advantaged and disadvantaged schools represent a critical equity issue for Australian schooling. While recommendations from the 2011 Gonski review of school funding attempted to address this inequity, it clearly continues.

    At a time of year when many advantaged schools celebrate their students’ high scores, it’s important to point out the contribution that disadvantaged schools have played in their success. It’s also timely to highlight the growing number of flexible learning programs in Australia that teach diverse student populations, including those with complex needs related to their disadvantage.

    These schools and programs too have valid stories to tell of their students’ successful academic and vocational results obtained under far less advantageous conditions. Unfortunately, these achievements are unlikely to appear on billboards or in newspaper articles.

    Maggie Callingham is a PhD candidate at the Victoria Institute for Education, Diversity and Lifelong Learning at Victoria University.

    This article first appeared in ‘The Conversation’ on 15 December 2014.