Pearls and Irritations Policy Series

Link to Fairness, Opportunity and Security.
Policy Series edited by Michael Keating and John Menadue. 

http://johnmenadue.com/blog/?p=3719

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John Menadue. The Greek crisis and regime change.

Current Affairs

A lot of the blame for the present crisis should be borne by many countries and institutions, but the one group that is least responsible is the present left-wing government of Greece, Syriza.

The major blame must rest first with the previous Greek governments that mired the Greek people in corruption and cronyism. The second group that must bear immediate responsibility is the incompetence of the Troika – the EU, the European Central Bank and the IMF, led very much by the German Government. The austerity campaign inflicted on Greece has resulted in the GDP shrinking by 25%, accompanied by unemployment of 25%, and youth unemployment of 50%. Such a situation is unacceptable and is likely to result in extreme outcomes. Something just has to give in Greece.

In this situation there are now suggestions reported by the London Times that ‘Germany will demand the Greek Prime Minister, Alexis Tsipras and Foreign Minister, Yanis Varoufakis, resign as a condition for a new Eurozone bailout.’ If this is correct it sounds very much as if regime change is being engineered. Is the object of such a plan to break the Greek Government so that the austerity plan of the northern European countries can continue? Such a plan is outrageous. These austerity plans have caused not only major social problems in Greece, but also in Spain where an election is due in December this year.

In retrospect, the Euro looks a bad idea, particularly when it links such diverse economies as Germany and Greece. Germany has gained economically from a weak Euro caused largely by the weak economies of southern Europe. It may not be overstating it to describe the Euro as really the Deutsche Mark in disguise. The Euro has given considerable benefits to German business and exporters. In turn, it has made southern European countries less competitive.

The austerity driven by the Troika with German leadership has resulted in political extremism of both the Left, as in Greece, and the Right, as in France.

For over a decade sensible economic management in Greece has been frustrated by widespread corruption and cronyism. Tax avoidance on a wide scale became acceptable by previous Greek governments. Urging Greece today to raise taxes to meet its budget deficits does not make a great deal of sense when so much tax is avoided. The crony friends of previous governments have become rich at the expense of the Greek economy and society.

The banks in Europe and in Greece have behaved irresponsibly with their loose lending. Just as it was incorrect to blame low paid Americans for accepting sub-prime mortgages, so the blame for borrowing by the Greek people cannot be sheeted home to poorly paid Greeks who needed credit to survive. It is noteworthy that in the present negotiations the banks have refused to include debt-relief as part of a settlement package.

Escalating public debt has been made worse by the irresponsible behaviour of Goldman Sacks. In 2002 Goldman Sacks helped Greece to mask its true debt. Goldman Sacks persuaded the Greek debt managers that they could avoid Maastricht rules on budget deficit limits. The result of the Goldman Sacks device was that $1 b. did not show up in the Greek debt statistics.

The overbearing attitude of the victors after WWI imposed a severe burden on the defeated Germany which it never forgot, with appalling consequences. In the US, the US Treasury decided to let Lehmann Bros fail to teach the market a lesson. The Troika in northern Europe seems intent on teaching the Greeks a lesson.

Instead of their resolve to crush the Greek upstart government, the Troika in Germany should look at their own failures and also the long-term future of Europe. The Troika has a lot to answer for in the current crisis. Hopefully a resolution can be found that respects the rights of the Greek people and place Europe on a continuing path of development.

See link below for an account by Jeffrey Sachs. He describes the behaviour of the Troika and others as ‘petulant, naïve and fundamentally self-destructive’. He adds that many of Greeks citizens are hungry, with conditions reminiscent of those in Germany in 1933.

Jeffrey Sachs is Professor of Sustainable Development and Professor of Health Policy and Management, at Columbia University. He is also Special Adviser to the UN Secretary General on the Millennium Development Goals.

http://www.spiegel.de/international/europe/greek-debt-crisis-how-goldman-sachs-helped-greece-to-mask-its-true-debt-a-676634.html

 

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Bob Kinnaird. China FTA ‘labour mobility’ fight looms

Current Affairs

The ALP National Conference at end-July will likely have before it an urgency motion demanding changes to the foreign worker provisions in the China FTA as a condition for supporting the agreement, according to The Australian (‘Change or block unjust trade deals, MPs told’, 26 June 2015).

Driving the move is a cross-factional group of eight unions concerned about the impact on Australian workers of FTA provisions mandating easier access to Chinese 457 visa workers, in some cases unrestricted access.

On top of that, it has now emerged that an FTA side-letter removes mandatory skills assessments for Chinese 457 workers in ten trades including electricians and the main construction trades. This directly contradicts Abbott government assurances in November 2014 that Australia had committed only to ‘improving access to skills assessments” in the China FTA.

Opposition Leader Bill Shorten wants Parliament to scrutinise the FTA and “the government to come clean on potential downside for Australian jobs and Australian safety and labour standards” (‘Union trying to cause a diversion: Robb’, The Daily Telegraph 29 June 2015).

Trade Minister Andrew Robb has said the government would not change the provisions in the deal “one wit” (sic) – presumably The Daily Telegraph meant ‘whit’. He was sure that unions opposing the deal ‘don’t understand’ the China agreement.

The unions increasingly understand what the China FTA labour mobility provisions actually mean for Australian workers, blue-collar and white-collar alike, but no thanks to Mr Robb. Instead of explaining and justifying these momentous provisions, Mr Robb and other Coalition Ministers have done everything to conceal the truth from the Australian community.

Immigration Minister Dutton or Assistant Immigration Minister Cash issued three media releases on the China FTA between 17 June when the deal was signed and 26 June – ‘New pilot visa to boost Australian tourism’, ‘New visa measures generate international buzz’ and ‘Minister Cash to visit China’.

In none of these statements do the Immigration Ministers even mention the momentous immigration concessions by Australia in the China FTA or their broader implications. The 457 visa program does not rate a mention, let alone that the China FTA removes the ability of all future Australian governments and Parliaments to apply labour market testing to all Chinese citizens in the standard 457 program.

Nor do the Ministers bother to even mention two other unprecedented immigration concessions by Australia in an FTA, or even outside an FTA: the ‘Infrastructure Facilitation Arrangements’ (IFAs) agreement with China allowing concessional 457 visas for skilled and semi-skilled Chinese workers, and the non- reciprocal ‘Work and Holiday’ visa agreement that provides ‘up to 5,000’ 462 visas each year for young Chinese to live and work in Australia for a year (extendable) with no reciprocal visa arrangement allowing any young Australians to visit and work in China, let alone 5,000.

These releases instead are mostly puff-pieces about the benefits for the tourism industry of changes to visitor visa rules for Chinese people, making it easier for Chinese tourists to visit and stay in Australia.

Minister Cash’s latest release informed us that in China this week she ‘will undertake meetings with Chinese government counterparts, industry stakeholders, and China-based Australian businesses’. This ‘is particularly timely given the historic China Australia Free Trade Agreement’ (among other things), her release said.

No further information was given about the Minister’s agenda for these China discussions. It may be that Australia’s Assistant Immigration Minister is, cap in hand, seeking Chinese approval for how the Australian government proposes to implement its FTA commitments on the IFAs in favour of Chinese 457 workers. The Australian Parliament will surely have a view about governments making Australian immigration laws in this way if it is presented with a fait accompli by the Minister when she returns.

Hopefully before the ALP National Conference the government does ‘come clean about the potential downside for Australian jobs’ in the China FTA, as the Opposition Leader has called for. If this was an honest government, it would admit two more downsides to its China FTA concessions that are fatal to its claims to be in Australia’s national interest.

First, the FTA 457 concessions give China increased scope to export some of its unemployment to Australia if things go bad in the Chinese economy, eg by pressuring Australian firms wanting Chinese market access or investment to take on Chinese workers over qualified Australians. By removing any legal obligation on employers to even look for Australian workers, the Abbott government is opening the door wide to this abuse of the 457 visa program.

Second, removing the ability of all future Australian governments to legislate in favour of Australian citizens and residents over Chinese citizens in the standard 457 visa program greatly increases the risk of future Australian job losses. It removes a vital policy tool Australia will need to manage future economic shocks including those arising from our increased exposure to China. On this ground alone it is reckless and irresponsible.

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

 

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John Tulloh. Why Eritreans are crossing the Mediterranean.

Current Affairs.

ERITREA: THE NORTH KOREA OF AFRICA 

It is the seventh youngest nation in the world. It was born in 1993 after a 30-year war. Its flag was raised for the first time as an independent nation with high hopes for democracy in a continent dominated by too many despots. In its first years it set an example of frugality when its people were encouraged to ride bikes and, what vehicles there were, had to be modest small ones. Its original leader is still in charge 22 years later. Time for an election? ‘Never’, he said. Instead he has created a harsh dictatorship with thousands of desperate citizens deciding life must be better elsewhere. Hundreds have died in the process. Their country has been likened to North Korea.

Such is life in Eritrea, the sun-baked former Italian colony on the African shore in the south of the Red Sea. Its people today cause nervousness in the capitals of Europe. They make up a considerable proportion of asylum-seekers risking their existence among the huddled masses crossing the Mediterranean to make a future in Europe.

Recently, the UN took a look at how the fledgling nation was doing. Its report was damning. The initial sense of democracy, it said, ‘has been extinguished by the government under the pretext of national defence’. The UN investigators said the regime of President Isaias Afewerki was guilty of extra-judicial killings, widespread torture, sexual slavery, Orwellian mass surveillance and enforced labour. In short, it may have committed crimes against humanity.

Eritrea has a system known as ‘national service’. The report says this really involves ‘arbitary detention, torture, sexual torture, forced labour and absence of leave’. Compulsory military service can be open-ended, continuing for years. Avoidance can lead to execution. Women recruits are rounded up to satisfy the lust of their commanders. Eritrea is a country ruled not by law, but by fear, said one of the UN investigators.

No wonder five percent of Eritreans have fled, according to the UN. Even that can be dangerous. Abandoning the country is regarded as treachery and until last year soldiers at border crossings routinely shot anyone trying to escape. It is a similar story for North Koreans who’ve had enough of their country.

It is a sad tale when the birth of Eritrea was greeted with such lofty expectations. A reporter for the Washington Post was moved to write:

     On a continent of millionaire dictators, where broken promises of democracy dovetail with collapsing living standards and unpayable debts, Eritreas revolutionaries hold out the possibility of an efficient, self-reliant African nation, run by Africans who have had 26 years to learn from the failures of independent Africa. 

     The trouble is that they didn’t learn or didn’t want to know. As a result, Eritrea has ended up like the Ethiopian regime – the Derg – which it fought for the three decades to get rid of. Its ratified constitution was suspended with no explanation and has now been abandoned altogether. Promised elections at the outset never took place and again without explanation. All private newspapers were closed and their journalists detained. Land was nationalised. Aid agencies were driven from the country. ‘Short of North Korea or an ISIS slave cave, there’s no more hopeless place on earth’, wrote Spectator columnist Mary Wakefield last month.

Eritreans in exile are unanimous in saying the villain for all this is President Alwerki. He apparently regards himself as indispensable and clearly sees himself as president for life – just like the Kim dynasty trio of tyrants in  North Korea. In a strange twist of irony, Eritrea in its written response denouncing the UN report lifted lines word for word from a North Korean fulmination to the UN on another matter:

“We are fully ready for any confrontation with the U.S. and will shatter the reckless “human rights” racket by the hostile forces through our toughest reaction. 

“The moves of the hostile forces to dare provoke the socialist system of the DPRK which was chosen and has been consolidated by the Korean people will not be able to escape disgraceful doom.”

The West pays little attention to Eritrea other than warning people travelling there. The EU in April approved an aid package of 122 million euros. ‘The more it gives, the faster the population decamps’, observed Wakefield.

The country is of little strategic value despite the Soviet Union once having a naval base there before independence. While Eritrea has a majority Christian population, more than 40 per cent of its people are followers of Islam. But no doubt the West is content in the knowledge that Eritrea’s brutal president will keep any Islamic radicals in their place.

Just as North Korean defectors have a tough time adjusting to life among even their own kith and kin in the south, for Eritreans it is an entirely new challenge in a new continent where they are far from wanted. ‘They were in Africa until yesterday and are fleeing like lost goats in Rome’, a social worker was quoted in The Times about newly-arrived Eritreans now trying to evade a different type of authority.

The number of Eritreans who made it to Italy by the boat last year was 40,000 or 23 percent of all asylum-seekers. That compares with just 32,000 of all asylum-seekers who made it to Australia by the dreaded boat in the 18 months to June 2013. The Immigration Minister, Peter Dutton, can only pale when this year’s likely record-breaking exodus across the Mediterranean is totted up.

If there is a glimmer of hope for Eritreans, it may be it’s because gold has been discovered in their benighted country and other minerals could be there as well. That’s if President Alwerki doesn’t follow the example of other African dictators by pocketing the money for himself and keeping his country to remain among the 10 poorest in the world.

FOOTNOTE: Australia has had a connection with Eritrea ever since 1987 when the late Fred Hollows began his work there to restore sight to thousands of people. Despite the crackdown on NGOs, the foundation in his name continues his work there today.

 

John Tulloh had a 40-year career in foreign news.

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Ian McAuley. The ABC and a second chance.

Current Affairs

Most reasonable people would be fully behind Mark Scott’s spirited defence of the ABC “as a public broadcaster, not a state broadcaster”, reminding us that “at times, free speech principles mean giving platforms to those with whom we fundamentally disagree.”

Tony Abbott’s reaction to Zaky  Mallah’s remarks on Q&A is comparable to the religious fundamentalists’ hysterical reaction to the Charlie Hebdo cartoons. When Abbott said “heads should roll”, he was undoubtedly speaking metaphorically, but such language spurs hotheads to extreme violence. It’s a chilling reminder that journalists have been beheaded for upsetting the delicate sensitivities of religious bigots.

How could Abbott, so familiar with Catholicism and English history, forget the unintended violence King Henry incited when, in a similar offhand remark, he said “who will rid me of this meddlesome priest”?

Of course Abbott and his loyal followers would be happy if all the media, particularly the highly-trusted ABC, were as uncritically supportive of the government as the Murdoch papers are. But the government doesn’t usually react so strongly as it has to the Q&A incident. Perhaps it touched a couple of raw nerves that other criticisms do not.

The first raw nerve was touched when Mallah suggested that the intemperate language of government ministers (“dog whistling”) has encouraged people to go to Syria to join IS. His statement was hardly elegant, and if taken out of context could be interpreted as urging people to join IS, but if one listens to the full interchange that is certainly not what he was saying.

It is quite plausible that government ministers and their strident supporters on talkback radio, have intentionally or otherwise contributed to a feeling of isolation and rejection among some young Muslim Australians, thus elevating the attraction of movements such as IS.  It’s a possibility worthy of serious consideration.

An academic or professional journalist would not have put the question in the same way that Mallah did, but Mallah is not an academic or journalist. As Shakespeare reminds us fools often speak truths in ways that more respectable people tend to avoid.

The other raw nerve touched by the incident was the audience reaction to Mallah’s suggestion that Steve Ciobo should leave the country. In one aspect it was simply a tit-for-tat return of Ciobo’s rudeness. But, asAnnabel Crabb  points out, what may have grated with the government was the applause from the audience.

Maybe the applause was just a normal “goodonyermate” approval of someone giving as good as he gets when confronted with ill-mannered behaviour, particularly when that behaviour is from a politician of the governing party.

But maybe it was more. A group of Australians, be they in a television studio or any other setting, carries the legacy of our convict history. That history is a rough one as Robert Hughes pointed out, but at its core is the story of redemption – the criminal whose death sentence was commuted to transportation and who made good in New South Wales, and whose genes so many of us now carry. Even though such successes were in the minority, the idea of redemption has helped shape our nation.

Mallah presented himself as the ticket-of-leave redeemed criminal. The audience was in no position to know whether that was contrived or genuine. But the reaction to the story was a very Australian one, by people who are on the side of redemption.

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Europe’s attack on Greek democracy.

See below link to article by Joseph Stiglitz in Project Syndicate. Joseph Stiglitz is a Nobel Laureate in Economics and University Professor at Columbia University. He was also Senior Vice President and Chief Economist of the World Bank.  John Menadue.

 

http://www.project-syndicate.org/commentary/greece-referendum-troika-eurozone-by-joseph-e–stiglitz-2015-06

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Ian Macphee. Celebrating the arrival 40 years ago of Vietnamese refugees and their contribution to Australia.

Current Affairs. 

Throughout Australia the Vietnamese community in Australia has been holding meetings to commemorate the arrival of the first Vietnamese refugees forty years ago. Sadly but appropriately these functions are also commemorating the wonderful leadership of Malcolm Fraser in welcoming the Vietnamese and consolidating the end of the White Australia policy. In this he was supported by the Labor Party and this bi-partisan policy continued until 1993 when mandatory detention was established by the Keating government. This worsened under the Howard government from 1996 onwards and the bi-partisan policy since has been inhumane.

Underlying the deep bond that Malcolm and I shared was our abhorrence of racism. It was a privilege to be his Immigration minister from 1979-82 and to welcome refugees from Vietnam, Cambodia and Laos. My close dealings with those refugees broadened and deepened my understanding of people. I listened to people in refugee camps in Malaysia and in settlement centres in Australia and understood challenges they faced in adjusting to the vastly different Australian culture. Not only did they integrate easily but also they have helped ease the ignorance of other Australians about other cultures.

Many Australians of Vietnamese origin have made varied public contributions, especially as governor, mayors, councillors, Constitutional Convention delegates and State Parliamentarians. Like other migrants they have moved to regional areas and spread understanding and tolerance as they assisted in the blending of cultures. The national identity which people must accept on arrival here is shared values of equality and compassion. Cultural interaction at work may identify new ways of doing things and improve productivity. And sports, art and other leisure activities can broaden open minds and enrich our culture in the process. At the 25th anniversary of the first arrival of Vietnamese in Sydney I felt an overwhelming joy as I gained an appreciation of the huge intellectual, cultural and economic contribution of a small wave of boat people.

We are socially cohesive because of our mutual striving for civilising goals. Bigotry mostly stems from ignorance. When we encounter bigotry we should confront it with reason. That challenge faces all in leadership positions, whether in politics, professions, media, religious institutions, educational institutions, sporting organisations or the workplace. Tragically, since 1993 our politicians have gradually abandoned humane principles and international law. Sensational tabloids and shock-jocks on radio and television engage in racist provocation.

The challenge for young people of all ethnic origins is to use social media to oblige our major political parties to return to humane values. If the major parties will not listen, young people must take necessary actions, form a new party to return to our shared values and devise a range of policies that reflect those values. That is important for Australia and its reputation in the world. We have lost respect and influence in our region and elsewhere since the rejection of bi-partisan humane policies. I beg young people to commence public debate on asylum seeker policy and its relevance to foreign policy.

Relevant to this is the Vietnamese Council of Australia. It was formed in December 1977 and has made a marvellous contribution with government agencies and NGOs to assist refugees gain jobs, health and education. The Council’s widespread activities also helped broaden Australians’ understanding of all people from Southeast Asia, especially Indonesia and Malaysia. The integration of Vietnamese has also helped Australians of Chinese origin to be treated more equally than many had experienced over many generations. But a new phase of the work of the Vietnamese Council lies ahead. It must combine with other caring groups to place grass roots pressure on our major political parties or help other parties win more support and influence.

The Rohingya crisis on the border of Myanmar and Bangladesh is appalling and the response of our major parties is disgraceful and undermines Australian values of “a fair go” as well as damaging our reputation elsewhere. While we are on the UN Security Council we should ensure that the UNHCR is properly funded and administered. At present it spends $3.3 billion on trying to help over 50 million displaced persons while we spend the same amount pushing boats away and imprisoning a few thousand. We should be working with our neighbours and the UNHCR to try to resolve the Rohingya crisis. That is the type of challenge that young Australians face.

I thank all Australians of Vietnamese origin for enriching my life and those of all Australians they encounter. In doing so I share your distress for the loss of your Father and Saviour and my dear friend Malcolm Fraser.
 

Ian Macphee was Minister for Immigration and Ethnic Affairs in the Fraser Government.

 

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Ross Kerridge. GP Remuneration.

Current Affairs

I understand that at the recent National Conference of the AMA there was general support for a move to help funding systems other than just fee-for-service. Ross Kerridge examines this issue below. John Menadue 

Healthcare Heroes. How to reward GPs for what they do best: a hospital specialist’s proposal

There is an old saying in healthcare: –   “If the GP is good, a specialist may be able to help. If the GP is bad, nothing will help.”  

The Junior Doctor has asked my advice about a 78 year old woman who has been booked for a hip replacement next week. She has the features common for her age – touches of heart disease, diabetes, emphysema, and her husband died three years ago. Children interstate. She’s maybe a bit forgetful. Not really sure about her regular medication, but says she is still living independently. “Seems a nice old lady and quite active but it’s a bit hard to be sure from just meeting her today.” 

Preparing her properly needs more information. So does planning her postoperative care. The GP is the key to sorting it out….. “OK, who is her GP?” I ask.

“She doesn’t have a regular GP any more. She goes to the 24-hour medical centre. We have two different versions of her medication and little information about her visits to specialists. She’s a bit vague about where she’ll go after discharge. The family situation might not be as good as she said at first….”

Heart sinks. Groan. Oh dear….

I start… “OK. She needs proper assessment. Can we get someone from General Medicine to check her over? What about Geriatrics? Has she had spirometry from the respiratory team? Does she need a cardiologist? Social work will need to be involved for discharge postop. We need results of bloods, echo, any other tests from the last year or two. Need to clarify the home and family situation. We could get caught here with her stuck in hospital and not able to go anywhere. Hmmm. This is going to take a while to sort out. We’d better postpone her op. Hopefully we can get someone else to take her place on the list…… I just wish patients understood why they need to get a proper GP.”

I feel a failure. But the system of Medicare payments has failed our patient.

Modern medicine can perform extraordinary things. But the major challenge of healthcare in the 21st century is coordinating all the ‘simple’ tasks: managing the evaluation, treatment and coordination of multiple chronic conditions in the elderly.   While patients and families must play a role, a single health professional needs to coordinate what is going on. And they should be paid for the value of that role. In Australia, the General Practitioner is the key to achieving this increasingly complex challenge. But Medicare does not support this role, and is increasingly undermining it.

Medicare is based on Fee-for Service payments. Services are defined on the Medicare Benefits Schedule. So a patient seeing a GP for a standard consultation can claim a standard rebate. For one-off patient problems, the Medicare system has worked well, and provides a baseline level of access to medical services. But patients have sets of inter-related problems. Bizarrely, Medicare does not reinforce the most important and valuable service that a GP can provide – that of co-ordinating and supervising all the various interventions by hospitals, clinics, specialists, allied health professionals and so on. The GP is not rewarded for providing a clear overview of what is going on, both FOR the patient, and ABOUT the patient (with their permission) to all those treating her/him.

Our health system is like a large collection of highly talented musicians all attempting to play a complex symphony. The GP should be the conductor of the healthcare orchestra, but they are not recognised (nor paid) for their crucial role of keeping everyone playing together. It is little wonder that the healthcare system often fails to function effectively or efficiently.

Some suggest that the whole Medicare Fee-for-Service structure should be completely reorganised and redesigned, with staff employed on salaries.   It is entertaining to talk about what a ‘perfect’ system would be like. But it is also nice to dream of peace in the Middle East.

Attempts have been made to provide special payments for the long-term management of particular (complex) conditions such as diabetes. These initiatives are a step in the right direction, but their aims have been seen as cost-cutting, rather than quality-improvement. Regardless, these schemes are fundamentally flawed because the complexity is not so much the disease itself, but the multiple ‘simple’ problems that occur together in the same patient. Or as William Osler, the ‘Father of Modern Medicine’ said, “The most important thing to know is not the disease that the patient has, but the patient who has the disease”.

Every system has advantages and disadvantages. Our current Fee-for-Service based Medicare system works well for simple one-off consultations.   It also has the advantage of being relatively easy to understand and administer.   The improvement most needed for Medicare is to modify the existing MBS schedule to provide recognition and payment for the Service that patients need.

There needs to be a new Fee (i.e. an MBS Item number) for ‘Supervising and Coordinating care’ for an extended period of time, over and above the current system based on separate episodes of care.

What would be the features of such a Fee?: –

  • The item would be paid to a single GP nominated by a patient (with the GPs agreement) to be their ‘Supervising Practitioner’ for an extended period (e.g. twelve months).
  • The new item would pay for an initial ‘health care planning consultation’, and then ongoing supervision of the patient’s care for the twelve months. Assuming both patient and GP are happy, the role would then continue as long as the patient was ‘on the books’ of that GP.
  • ‘Normal’ (one-off) consultations would continue as now, with the patient able to choose anyone to attend, but with a requirement that any service provided under Medicare would include providing a report to the ‘Supervising Practitioner’.
  • The Supervising Practitioner would be responsible for maintaining the patients record (i.e. receiving and filing the above) and (with the patient’s consent) providing necessary information to other appropriate practitioners.
  • The fee would be scaled for increasing clinical complexity. More complex patients may require a ‘Planning Consultation’ more frequently, such as three-monthly. There could also be a loading for rural, remote, frail elderly or ‘challenging’ patients.
  • An ‘old-style’ GP practice, providing the valuable service of coordinating and supervising a patient’s long-term health care, may be able to derive (say) 20% of their income from this payment.  A medical centre providing single-consultation without ongoing commitment would not gain the coordinating fee.

This plan would reinforce the strengths of Australia’s existing system of GPs being the foundation of the healthcare system. It rewards GPs who attract patients who are healthy and use self-maintenance to avoid medical consultations.  It provides a framework to encourage GPs to move to underserviced areas where they will gain income for having patients ‘on their books’. It acts to shift the balance away from high-activity clinics focussed on short-term one-off consultations.  It reinforces the status and importance of good patient-centred medical care.  It might also encourage GPs to develop models of care less dependent on requiring the patient to physically attend the consultation.   This may particularly help complex patients such as disabled, frail aged, or residential care patients.

The cost of this new item could be offset by removing some of the current ‘add-on’ programs that are costly to administer and do not necessarily or systematically encourage long-term supervision of care.  It would also result in a reduction of waste because it would reduce duplication and provide a single place of reference about the patient’s health care.  Treasury would be delighted to know that this particular part of the healthcare budget was fixed – each Australian could only generate one fee annually.

The system would enhance the status, rewards, and professional satisfaction for ‘traditional’ GPs as the foundation of the healthcare system. This may encourage more young doctors into general practice, by formalising a position of the ‘supervisory GP’; the GP’s involvement in high-stakes decision-making (such as planning complex surgery, or care at the end of life) would be established. This would clarify decision-making in hospitals considerably.   Most importantly, it would improve long-term patient care.

This modification to Medicare maintains the positive aspects of the Fee For Service system, but rewards important long-term patient care that is not funded by the current system.  It can be implemented as a modification of the current system without major redesign, but would nevertheless have major positive ramifications.

The Medicare system is imperfect. Some dream of major reform and wholesale redesign. Maybe that can happen in the long-term.

But in the meantime, who is your GP?

Associate Professor Ross Kerridge is an Anaesthetist and Perioperative Physician at John Hunter Hospital, a large teaching hospital in Newcastle. He is Associate professor at University of Newcastle and a member of AMA NSW State Council. These are his personal opinions.

 

 

 

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Walter Hamilton. Why I am an Australian citizen

Current Affairs.

Amid all the howling about terror, treason and the ABC, Australians seemingly have lost the ability to stop, listen and think. Everyone is in such a hurry to outdo the next person in vilifying and repudiating the ‘other’, whether it is a Muslim Australian, a political opponent or a commercial rival. I can’t remember when the fabric of public debate has been so tattered by prejudice, ignorance and a determined refusal to listen to the other point of view.

I am not a regular watcher of ABC-TV’s Q&A; I don’t like the format, and I feel sometimes it has been part of the problem in the way issues are debated and analyzed in this country. So this is not a defence of a particular program or a particular voice on that program. What I want to say, however, is that if we prefer silence to allowing the expression of opinions that annoy or exasperate us therein lies a terrible danger. Only totalitarian states prefer the elevator music of perfect agreement.

Let me just say this about the individual concerned. Critics constantly remind us that he is a convicted criminal, as though any citizen who has been punished under the law is no longer entitled to a voice. This idea should be anathema in a democracy, and yet it plays straight into the government’s campaign to curtail the citizenship rights of a specific group of people through the use of powers that emanate from outside the judicial progress.

The ABC’s managing director Mark Scott made an important point this week when he emphasized the distinction between a public broadcaster and a state broadcaster. The ABC was part of Team Australia, he said––repudiating Tony Abbott’s slur––because it played the necessary role in a democracy of providing a forum for debate free of political interference.

As further evidence that people don’t listen, a member of the Greens then criticized Scott for allegedly sacrificing truth to patriotism. He had missed the point completely: the ABC should not, and does not, stand outside Australian society; its role is to strengthen the social fabric by giving expression to all its parts.

And then there’s the debate over how the families of dead ISIL fighters from Australia should be treated.

I was astonished to hear Labor’s Bill Shorten join the ugly chorus of ‘I wouldn’t let my kids near him’ in reference to the seven-year-old boy coaxed by his father into posing for a photograph with a severed head in Syria. The boy was seven, Bill. Talkback radio has been full of voices repeating the same mantra: shun him; we don’t want them back; let them fetch for themselves. Unclean, unclean!

Once upon a time Australia used to be referred to as a Christian country. Even today, beneath the intolerance for the Muslim veil and beard is an affirmation of ‘Christian’ superiority. What became of the central Christian principle of forgiveness? What became of the core Australian principle of fairness? Should we not be reaching out to those Australians, wherever they are, whose lives have been marred by the actions of others, fanatical fathers and possibly mothers?

Tony Abbott says they will be treated just the same as the families of other criminals. Of course, none of these ISIL fighters has been convicted of anything in a court of law––though perhaps that’s too nice a point during this time of bludgeoning debate. In any case, as I have already pointed out, being a convicted felon (and having served your time), according to some people, is now sufficient reason for the ABC to need to exclude your voice from the airwaves. Perhaps all ex-cons should be stripped of their citizenship? What are the limits of the politics of vilification?

Perhaps you heard in the news this week that the city of Kobane, near the Syrian border with Turkey, was cleared of ISIL by Kurdish militias after months of fighting. Western news media entering the city found a scene of total destruction: not a building intact, a vast grey pile of rubble. Within a day, ISIL elements were back in the city on a savage rampage against the civilian remnants.

In this sort of contest, there is no ‘to the victor, the spoils’; total warfare means total destruction. For liberal societies such as ours, the challenge we face is not to be the first to don fatigues and lay waste (rhetorically or otherwise) to any and every perceived opponent, before he ‘gets’ us. The challenge is to preserve the reasons for our opposing violence, intolerance and oppression, and live out those reasons every day in the way be conduct our civil society.

We must not tear down the institutions and the laws that protect us from within, as we attempt to mount a defence against perceived and real threats from without. Pause, listen and think.

Walter Hamilton reported for ABC for more than 30 years.

 

Posted in 3. CURRENT AFFAIRS, Foreign Affairs, Guest bloggers, Media | Tagged , , , , , | 1 Comment

Mark Scott. The ABC belongs to all of us.

Current Affairs.

 Address by Mark Scott
Centre for Corporate Public Affairs’ Annual Corporate Public Affairs Oration
Thursday 25 June 2015

From time to time, I’m asked to speak to journalism students about what it’s like working in a news room.

I often reflect that for all the planning you can do around big news events—an election, a budget, The Olympics—almost by definition, the biggest stories are those you can’t predict, you didn’t know were about to erupt.

These kinds of stories are sometimes fascinating, sometimes appalling. But they get the adrenaline running in the newsroom.

Thinking about it now, I suspect that those of us running corporate affairs, as you do—or running a corporation as I do—don’t hanker for the adrenaline rushes quite so much!

But things happen. As Harold McMillan said when asked what were the greatest challenges a leader faces in public life, “Events, my dear boy, events.”

So, given the events of the week including the government’s announcement of an inquiry into the events surrounding Monday’s Q&A plus the commentary and questions that have erupted about the role of the ABC, I thought it would be appropriate to address some of these issues with you tonight.

As you know, Monday night’s Q&A triggered very significant debate and controversy. A man who had been tried and acquitted of planning a terrorist attack, who pleaded guilty to threatening to kill ASIO officials, applied to be in the studio audience and to ask a question.

It is not as though this man was unknown to the media. He’d appeared on numerous occasions previously across a number of networks. He’d been in the Q&A audience before.

As someone said to me this week, free speech arguments would be easier if you were always defending Martin Luther King. At times, free speech principles mean giving platforms to those with whom we fundamentally disagree.

It was the crux of the Charlie Hebdo argument last year and of course, the source of the maxim that was used to describe Voltaire’s beliefs—“I disapprove of what you say, but I will defend to the death your right to say it.”

Media organisations often give airtime to the criminal and the corrupt. To those who express views that run contrary to accepted public values. You have to set the bar very high before you begin to exclude certain views or perspectives.

We still need to hear in order to gain insight into thinking, into motivation. To understand the root cause of behaviours and actions that we might find confronting and alarming, or worse.

The man who appeared on Q&A had been given considerable space by numerous media outlets in recent years. If giving him space or time to express his views is an act of sedition, then the round up of the seditious will take some time and include, I should add, The Australian newspaper which ran an extensive article on him in 2012, charting his journey from when terrorism charges were first laid against him. He also graced the pages of The Courier-Mail.

However, as we said at the ABC on Tuesday morning, other issues were triggered by giving this man a forum on live television through Q&A that are not free speech issues. I can see circumstances where a question asked by this man could have been broadcast, just as other controversial figures have asked questions on Q&A before, like Julian Assange.

The risks and uncertainities of having him in a live programming environment weren’t adequately considered before the decision was made to accept his application to be in the studio audience.

It’s one thing to pre-record an interview and exercise editorial judgment on the content before you put it to air. But live television doesn’t give you that option. And in Q&A’s case, it took place with a large studio audience present. The ABC’s immediate statement, on Tuesday morning, made this clear.

These things needed to have been thought through carefully and referred up internally. We have detailed upward referral on editorial judgment at the ABC to help guide thinking in complex or contentious matters.

We’re also aware of potential security issues and are, in fact, talking to the AFP to ensure they are completely appropriate for the program.

Now there are some ABC staff, present and past, who argue that to make any concession in the face of criticism is to buckle. Who say it’s a sign of weakness. Respectfully I disagree.

It’s not weakness to say you made the wrong call. We have no problem with that. People who are equally well-meaning will often make different judgments. The judgments that count in this matter are the ones made by those paid to make them. Those at the program, and those in the editorial chain-of-command above them that leads to me, reporting to the Board.

The ABC is reviewing the decision-making processes around Q&A in light of this experience. This is happening internally, now. And the Board had previously determined that Q&A would form part of this year’s series of independent editorial reviews it commissions.

It will be undertaken by someone external to the ABC and will look across all aspects of the program across a range of episodes. Its considered findings will be released later in the year.

The ABC will co-operate with the Government’s snap inquiry, which is to report back next Tuesday.

We know that live television is dangerous. That it can be unpredictable and compelling. Part of the success of Q&A is that the audience knows it’s live. It’s event programming. And viewing numbers increased significantly when the show commenced broadcasting live tweets on the screen. Many in the audience leaned in, got even more involved.

Q&A has a lot of moving parts—pulling together the panel, bussing people in from all over the place, getting a balanced studio audience, selecting the questions and tweets. It’s hardly a straight-forward proposition, and that’s further fueled by the electricity of the live production.

I admire those who accept what can be the ultimate challenge of being on the panel, to test their arguments and their wit, live in front of a million people. The studio crowd can be rowdy, vocal, unforgiving. It is easy to find excuses not to come on the panel, but to say yes, to turn up—you need ticker. It’s a Todd Sampsonesque piece of heroics. You’re on the high wire without a net. And that’s not just the panel—it’s the same every week for the host and the senior producers.

As we know, Q&A engages audiences and it triggers a response from them too. People will not be happy with every panel or questioner or tweet. Not every editorial judgment made will be right. The show generates passion like few others. No program is more heavily scrutinised by audiences and critics.

I feel that Q&A has all the potential of being a 20+ year franchise for the ABC, so we need to treat it with care. Like Four Corners, it’s a show that should endure when all current management and production teams are long gone, an enduring part of Australian public life. Those of us who have responsibility for it now are trustees for its future.

Amidst this week’s controversy, I don’t want to lose sight of the terrific achievements of Q&A. Extraordinary programs on mental health and AIDS. The remarkable program from the Garma forum. Shanghai. Delhi. Those times we felt we were having a really intelligent, engaging national conversation around the things that matter most.

And while we remember these special episodes, it is also worth remembering that our highest rating Q&A episodes are often the regular ones where politicians and community leaders thrash out the issues of the week. It has become a staple in the lives of many Australians, every Monday night.

We will reflect on the events of this week, have the program independently reviewed and look to ensure that it pursues and delivers its potential to be public broadcasting at its best – to inform, to educate and to entertain.

The media firestorm that has erupted around Monday’s Q&A was ferocious, but as a public broadcaster, the ABC goes through these from time to time. At times I have felt that, compared to our Commonwealth public broadcasting cousins in the UK and Canada, we go through relatively few.

But even for the ABC, things seemed to have been taken to a new level when on Wednesday we scored four covers on one day in the News Limited tabloids, complete with photoshopped ABC flags being waved by jihadi protestors. Not all parties to the conversation have seemed vested in pursing a rational discourse.

A question was posed this week. Whose side is the ABC on? It’s not the first time it’s been asked. Menzies, Hawke, Neville Wran—they all asked it in their own inimitable ways.

It’s a good question. And while it’s often asked with a rhetorical flourish, a question about the role and nature of the public broadcaster in these highly polarized and partisan times, it’s a fair one.

Sometimes it seems questions like this are framed to cause doubt. To challenge what we have always felt. And while rhetorical questions are designed to be posed and not answered, I want to answer this one.

It’s important.

Whose side is the ABC on?

Well in any team, you can be playing on the same side, but often you will be playing in a different position, with a different role and responsibility. You’re on the same side, but with a different job to do. You do your bit and you work together to make the team successful.

The ABC is clearly Australian, it’s on the side of Australia. The A in ABC is for Australian. And the part we play, what we do for the side, is a vital one, central to our culture and our democracy – that of being an independent public broadcaster.

The ABC’s Charter covers our responsibility to Australians who live in this country and also Australians living overseas. Our wide, diverse programming reaches Australians everywhere across the land.

Inside the ABC, we talk about wanting to be the independent home of Australian conversations, culture and stories.

Central to the legislation establishing the Corporation is the independence of the public broadcaster. Funded by Government, accountable to the public for its performance, governed by a Board of eminent, independent Australians.

And of course, it’s precisely this independence that shapes the ABC as a public broadcaster, not a state broadcaster.

A state broadcaster is the communications arm of the Government. Its role is to communicate the messages of the Government—and certainly not to do anything that undermines the Government.

I hope no-one seriously wants the ABC to be a state broadcaster.

We know the examples. North Korea and Russia. China and Vietnam. There are many others.

But that has never been the role of a public broadcaster here, a public broadcaster formed in the tradition set out by Lord Reith the first head of the BBC, who spoke of a duty to inform, educate and entertain.

The Reithian tradition shapes the history of the ABC. Its independence enshrined in legislation and entrusted to the Board.

The ABC Act does not envisage the ABC as another branch of Government public relations. Instead, it asks the ABC to provide an independent national broadcasting service. And the Board is asked to maintain that independence.

The ABC’s Editorial Policies state that “the trust and respect of the community depend on the ABC’s editorial independence and integrity. Independence and responsibility are inseparable.”

The first editorial policy says to maintain the independence and integrity of the ABC.

There are good reasons for independence from Government, just as there are good reasons for an independent judiciary.

Australians cherish freedom of expression, and they cherish debate. They cherish the role of the ABC in facilitating both.

When we were planning television in Australia sixty years ago, we came up with our own model, an Australian model that offered us the best of both worlds.

When it came to the public broadcasting side of it, we didn’t do what the British had done when they made the BBC a monopoly.

We didn’t what the Americans had done, creating public television only later on, almost an afterthought of the Johnson presidency.

We didn’t do what Italy had done, with three national channels allocated to three leading political parties. Nor did we follow the French example, where the top jobs at the public broadcaster would change when the party in Government changed.

In Australia, when Governments change, we could change the public broadcasters with them, align them to more positively reflect the Government’s agenda, to do the Government’s bidding.

But you would have to change the ABC Act.

And you would have to destroy the ABC as we have known it for eight decades.

Instead, Australia has an independent ABC and that independence is key to its credibility. It’s why trust in the ABC is streets ahead of commercial media. The Essential Poll conducted earlier this week demonstrates that far more Australians put their trust in ABC TV news and current affairs, than other media outlets.

It’s why the ABC is one of the most trusted institutions in the country, along with the High Court and the Reserve Bank.

I think you’ll find that in Australia, as in every country where public broadcasting exists, “The most trusted public broadcasters are those that are perceived as closest to the public, and most distant from the government”, as the Nieman Journalism Lab at Harvard noted in its review of NYU’s research paper Public Media and Political Independence.

The history of the ABC is a history that shows the anger and frustration of Government at ABC broadcasts from time to time. Ken Inglis’ two histories of the ABC document these stoushes at length.

Those of you with longer memories will recall the harsh criticism dished out by the Hawke Government over the ABC’s coverage of the first Gulf War.

In my nearly nine years at the ABC, when we’ve had Governments both Labor and Liberal, there have been ABC stories that generated the wrath of the Government of the day. Monday’s Q&A is but the most recent example.

Of course there will be stories that frustrate politicians. Of course there will be coverage that’s not of their choosing. But my experience has been that most politicians have understood the importance of the independence of the public broadcaster from political pressure and interference. It’s a mark of the maturity of our democracy.

Most—though some, aren’t reluctant to turn up the heat now and again to see what happens.

Long may that independence continue.

And as it does, it is vital the ABC appreciates that independence and responsibility are inseparable.

The ABC is not perfect, and while it sets high standards, it won’t always meet them. There will be poor journalistic practice or poor editorial judgment shown occasionally, and criticism of the ABC will be well founded.

Good journalism is strengthened by setting the record straight. That’s a responsibility as well. The finest media outlets are those who, in taking accuracy and the truth seriously, willingly concede error. And then put things right.

Of course, there are times when someone thinks a story is inaccurate when it’s simply speaking an inconvenient truth. Other times stories will cause frustration and embarrassment—to Government, to business, to unions, to leading social institutions. That’s what public accountability is all about.

Stories that people would rather not have been told. Stories that are immediately attacked, but over time are revealed to be right and of overwhelming public importance.

Witness the Royal Commission into the institutional response to child sexual assault. The ABC was at the forefront of uncovering the stories that led the establishment of the landmark review. Look Four Corners and Lateline’s coverage of endemic poverty and appalling living standards in Indigenous communities.

Journalism served the public interest in bringing the corruption in Queensland under Premier Bjelke-Peterson to light. In revealing the appalling treatment of customers by financial planners at the Commonwealth Bank, cruelty in the greyhound industry, the callous behaviour of James Hardie, the deception of cash for comment in commercial radio.

The ABC serves the public interest in this way through hundreds of stories a week, from the biggest cities to small country towns.

These are the contributions made by an independent public broadcaster. Independent from pressure by advertisers or proprietors. Independent from the need to maxmise sales or advertising. Independent from a Government dictating the coverage it wants or needs.

Independent from these pressures but responsible under the ABC Act to deliver journalism that is accurate and impartial to the recognised standards of objective journalism.

It’s journalism that means speaking truth to power. Pushing for disclosure and transparency. Seeking to verify that which we are asked to take on trust. Asking difficult questions. And bringing to light views that are very different to ours, being challenged and confronted—to increase our understanding and insight, if not our acceptance.

The stakes don’t get any higher than when reporting on national security. Not just in keeping citizens safe, but keeping our nation sound as well as safe—our privacy protected, our democracy robust, ensuring the integrity of our institutions, the honesty of our politicians and that our rights as citizens are being respected.

In doing this important work in our journalism, the ABC is also held to account for our decisions and our performance.

The ABC’s accountability mechanisms are more robust than those of any other media organisation in the country.

The Annual Report details the operations of the independent complaints division run by the ABC that looks into every material complaint submitted by audiences. The A.C.M.A. can review decisions made by that complaints division.

At least three times a year there are public Senate hearings where, along with other ABC Executives, I answer a vast range of questions for hours —and hundreds of others are put on notice.

Detailed reporting on the ABC’s expenditure goes to the Department of Finance in Canberra.

Even our own program, Media Watch, casts a critical eye as intently over the ABC as it does other media outlets.

The ABC Board is now commissioning its own independent reviews of editorial content to go alongside the extensive financial auditing process. These reviews are just part of the Board’s response to its editorial responsibilities under the Act.

It is unparalleled compared to any other media organisation in the country, and rightly so. We are spending taxpayers dollars and with the right to practice our craft, comes responsibility and accountability for performance.

Much of what I have discussed tonight goes to our journalism – a vital part of what we do. But it is only part. Only part of the role we play.

I have sometimes had to say to politicians that they do seem to get obsessed about 2% of the ABC’s content—usually the part that’s about them or the issues their polling currently says is important.

But the ABC is for all Australians and it’s much bigger and broader and richer than that.

Political content certainly gets the attention of our audiences. They engage with Q&A, Insiders, 7.30, AM and PM.

But if you look at the numbers, this is but a small fraction of the audience’s ABC experience across radio and television, online and mobile. From Play School to Charlie Pickering, from Matt and Alex to Mad as Hell, to our famous medicos, Dr Norman Swan and Dr Lucien Blake—they represent the ABC for millions of Australians for hours every week.

We celebrate Australia at the ABC. We celebrate important national events and the lives of Australians. The great, the unknown.

Witness our coverage on Anzac Day. Dawn Services around the country, marches in capital cities, commemorations from Anzac Cove and Lone Pine.

And on Australia Day, bringing the stories of the Australians of the Year and the National Flag Raising and Citizenship Ceremony.

Having national conversations on absolutely crucial matters like mental health during our Mental As week.

Bringing Australians together to raise $5m in just a few days for relief efforts in Nepal.

We have been doing this kind of work for years and years.

In November we commemorate 70 years of The Country Hour. Next year marks 20 years of Australian Story. Since 1932 on radio we have had local voices, telling local stories to local communities.

As The Sydney Morning Herald noted when the ABC turned 75—you would still have an Australia without the ABC, but it wouldn’t be this Australia.

This Australia owes much to the ABC. Because the ABC is an indispensible part of Australian life and part of the lives of millions of Australians each day.

That’s why well over 80% of Australians believe the ABC provides a valuable service.

It’s valuable when it discovers brilliant new Australian musical talent that will conquer the world through triple j unearthed.

Valuable when we listen to the beautiful work of ABC composers recorded by the ABC Classics label.

Valuable when we hear Jim Maxwell, in the dead of night, calling the Ashes from England.

Valuable when we’re listening to the birdsong on Macca on a Sunday morning.

When we’re absorbed by the best television drama of the year—The Secret River. And the most compelling docudrama for a decade, The Killing Season, which led to the cry during Question Time last week, “Thank you to the ABC”.

The work of the ABC, what it adds to our lives, reminds me of the words of the US physicist Robert Wilson. Wilson had been called to testify at a congressional hearing in the late 1960s. He was being challenged by Senator John Pastore about the rationale for the government spending $250m on a new scientific investment. Pastore asked whether Wilson’s work had anything to do with promoting “the security of the country”.

Wilson said it didn’t—none at all. But he then pointed out this kind of work “only has to do with the respect with which we regard one another, the dignity of men, our love of culture. . . . It has to do with whether we are we good painters, good sculptors, great poets? I mean all the things we really venerate in our country and are patriotic about. . . . It has nothing to do directly with defending our country—except to make it worth defending.”

And that is the key answer to the question about the role ABC plays in Australia, the part we play on the team.

For we are the independent home of Australian conversations and culture and stories.

Reaching Australians everywhere on radio and television, online and mobile.

Celebrating achievement. Sharing discoveries. Uncovering truths.

Talking about the things that matter. A place where Australians can come to talk and listen, to watch, to share.

Helping us understand each other and this country better.

To help make Australia, Australia.

And that’s how we fulfill our part on the team.

 

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