COMING SOON – Mike Keating and John Menadue (joint editors). POLICY SERIES

Mike Keating and John Menadue (joint editors)
Fairness, Opportunity and Security -filling the policy vacuum

There is a growing public disquiet that both the government and the opposition keep playing the political and personal game at the expense of informed public discussion of important policy issues.

As a community we have become concerned about the trustworthiness of our political, business and media elite. Insiders and vested interests are undermining the public interest. Money is unduly influencing political decisions. There is gridlock on important issues like climate change and taxation.

After a near death experience Tony Abbott has said the he is open to new thinking and ways of governing. Time will tell. Bill Shorten has said that 2015 will be the year of ideas. We hope so.

From early May in this blog we will be posting a series of articles on important policy issues. Mike Keating and I will be joint editors.

 There will be over 40 policy articles .Each of the articles will be about 2000 words.

They will be   realistic, given our political and financial constraints.

It is planned that these policy articles will be published in a book by ATF Press in October/November this year  

Policy areas to be canvassed

Economic policy
Fixing the budget
Taxation
Federalism

Productivity
Job creation and participation
Foreign policy
Security, both military and soft power
Health.
Development of our human capital in the fields of education, science,  research and development and innovation.
Transport and infrastructure
Population/migration/refugees
Welfare priorities.
Retirement incomes
Indigenous affairs
Communications, the arts, media and culture.
Environment and climate change
Inequality
Role and responsibilities of government
Democratic renewal – the lack of trust in government and the hollowing out  of our political  parties.
Internal security and freedom.

 

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Frank Brennan. ANZAC Centenary Homily.

 ANZAC Centenary Homily

Harvard Memorial Church

25 April 2015

Fr Frank Brennan SJ AO

Homily

This Memorial Church here at Harvard was dedicated on Armistice Day 1932 in memory of those who died in World War I.  The inscription over the south entrance to the memorial room reads, ‘In grateful memory of the Harvard men who died in the World War we have built this Church.’

It is fitting that we, Australians, New Zealanders, Turks and Americans should gather in this place to mark the centenary of Anzac Day, the day on which Australians and New Zealanders landed in the stillness of the early dawn on the Turkish shoreline wanting to assist with the Allies’ advance on Constantinople, now Istanbul, the day on which the Turks commenced a successful, eight month campaign to defend their homeland against the assault.

Nineteen years after the ANZAC landings, Mustafa Kemal Ataturk, Founder and first President of the modern Republic of Turkey, who had been Commander in Chief of the Turkish forces in Gallipoli, graciously responded to an Australian journalist’s request and wrote, ‘The landing at Gallipoli on April 25, 1915, and the fighting which took place on the peninsula will never be forgotten. They showed to the world the heroism of all those who shed their blood there. How heartrending for their nations were the losses that this struggle caused.’  A century on, we, the people of both sides of that deadly struggle can gather, people of all faiths and none; we gather in peace, espousing the virtues of all who fought and daring to pray together for peace and reconciliation between us and amongst all peoples.  We gather together helping each other to repair the heartrending and to prosper as best we can from the tragic, irreparable losses.

We remember the 130,000 who were killed on that blood-soaked peninsula during the Gallipoli campaign, and the other quarter of a million who were wounded.  A century on, we have gathered more inclusively and not just to pray for the 44,000 Allies who died, but also for the 86,000 Turks who perished in their trenches opposite them.  Being ANZAC Day, we particularly call to mind the 8709 Australians and 2779 Kiwis who died.  A handful at the time were honoured by name for particular military feats, ‘but of others there is no memory; they have perished as though they had never existed; but these also were godly men, whose righteous deeds have not been forgotten; their descendants stand by the covenants; and their glory will never be blotted out’. (Ecclesiasticus 44:8-14)

We recall the innocence of the soldiers – many aged the same as many of those who today study here at Harvard – and the human values that they embodied of courage and mateship. We recall too the reality, routine and relentlessness of their fighting, their sufferings, and their deaths.  We also recall the idealism, the hope, and perhaps even the naivety of empire which motivated and sustained them and those who sent them to battle.  The ANZACs had sailed from Albany in Western Australia on All Saints Day, 1 November 1914.  They waited in Egypt and then joined the Mediterranean Expeditionary Force of 75,000.  They landed early morning, and in the wrong place. Because of navigational errors the ANZACs landed about 2 km north of the intended site. Instead of a flat stretch of coastline, the boats carrying the 1500 men who would make the first landing came ashore at what is now named appropriately Anzac Cove, a narrow beach overlooked by steep hills and ridgelines.  Thus began an eight month campaign of combat in muddied trenches infested by lice, swarmed by flies, and putrified by faeces.

Back home, their political masters were sustained both by the pride of selfless colonial service to empire and by the hope of imminent military success.  At 3pm on 29 April 1915, Australian Prime Minister Andrew Fisher rose in the House of Representatives and proudly declared:[1]

Some days ago the Australian War Expeditionary Forces were transferred from Egypt to the Dardanelles. They have since landed, and have been in action on the Gallipoli Peninsula. News reaches us that the action is proceeding satisfactorily. I am pleased to be able to read the following cablegram received to-day from the Secretary of State for the Colonies: — 

His Majesty’s Government desire me to offer you their warmest congratulations on the splendid gallantry and magnificent achievement of your contingent in the successful progress of the operations at the Dardanelles. 

To this the following reply has been despatched through His Excellency the Governor-General: — 

The Government and people of Australia are deeply gratified to learn that their troops have won distinction in their first encounter with the enemy. We are confident that they will carry the King’s colours to further victory.’ 

Next day Fisher read to the House a telegram from King George dated 29 April 1915:[2]

I heartily congratulate you upon the splendid conduct and bravery displayed by the Australian troops in the operations at the Dardanelles, who have indeed proved themselves worthy sons of the Empire.

On 5 May 1915, ten days after the Gallipoli landing, Australian members of parliament were agitated that the Melbourne press were carrying details of New Zealand casualties but there were still no public details available of Australian casualties.  A question was put to the Assistant Minister for Defence:

In view of the many messages of congratulation that we have received regarding the bravery of our troops in action in the Dardanelle, is the Assistant Minister of Defence in a position to tell the House with what result the bravery of our men has been attended?

The answer was a simple, haunting three words: I am not.[3]

Gradually, the political masters and then the people became apprised of the more gruesome reality on the other side of the globe.  A century on, we balance the idealism of service to empire, the reality of death in the trenches, and the prospect of reconciliation with former enemies in scales which only grace and forgiveness can hold. ‘Their bodies are buried in peace, but their names live on generation after generation.  The assembly declares their wisdom, and the congregation proclaims their praise’. (Ecclesiasticus 44:14-15)

Over the generations, we have reached out across those trenches that divided us.  We have embraced a more sustaining myth, a more noble ideal: the brotherhood of man, the dignity of our shared humanity.  We have appropriated the words attributed to Ataturk at the 1934 dawn service which will be recited for us by His Excellency Omur Budak, the Consul General of Turkey: ‘There is no difference between the Johnnies and Mehmets to us where they lie side by side in this country of ours….After having lost their lives on this land they are now our sons as well.’

Despite the instability and the intractable conflicts on Turkey’s borders today, we dare to gather in prayer dreaming of ‘a new heaven and a new earth’ in which the God of Abraham, the God of Isaac, the God of Jacob ‘will wipe every tear from their eyes’ so that ‘mourning and crying and pain will be no more’. (Revelation 21:4) We hear the word of Revelation proclaimed to all people of good will, to all peacemakers including those who have fought, those who are fighting,  and those who will fight so that there might be no more war: ‘I will be their God and they will be my children’.  (Revelation 21:7)

Today, lest we forget.

They shall grow not old, as we that are left grow old:

Age shall not weary them, nor the years condemn.

At the going down of the sun and in the morning

We will remember them.

May the Aussies, the Kiwis and the Turks amongst us this morning go forth into Harvard Yard carrying and sharing the memories of those who encountered each other for the first time across trenches a century ago, committing ourselves afresh to transforming our heartrending and our losses into heartmending and tangible dividends of peace for our world.

Prayer 

Let’s all pray in silence, each in their own way.

I will now offer a Christian prayer:

Lord Our God, on this day, 100 years ago, the Australian  and New Zealand Army Corps, at Gallipoli, made immortal the name of Anzac and established an imperishable tradition of  selfless service, of devotion to duty, and of fighting for all that is  best in human relationships.

O Lord, we who are gathered here today from both sides of that conflict remember with gratitude the men and women who have given, and are still giving all that is theirs to give, in order that the world may be a nobler place in which to live.

And with them, Lord, we remember those left behind to bear  the sorrow of their loss.

We dedicate ourselves to taking up the burdens of the fallen and, with the same high courage and steadfastness with which they went into battle, to setting our hands to the tasks they left unfinished. Lord, we dedicate ourselves to the service of the ideals for which they died.  With your help, O God, might we give our utmost to make the world what they would have wished it to be, a better and happier place for all of its people, through whatever means are open to us.

We make this prayer through Christ Our Lord. Amen.

[1] Commonwealth Parliamentary Debates, House of Representatives, 29 April 1915, p. 2724

[2] Commonwealth Parliamentary Debates, House of Representatives, 30 April 1915, p. 2814

[3] Commonwealth Parliamentary Debates, House of Representatives, 5 May 1915, p. 2832

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Mark Triffitt and Travers McLeod. Hidden crisis of liberal democracy.

A “burning platform” with big, tangible impacts on our everyday lives is often the tipping point for concerted action. We call these crises.

Think of the G20’s actions in the wake of the global financial crisis or the global response to 9/11. Both events left governments and decision-makers with no choice but to act.

Then there are the hidden crises. These are usually not a single, explosive event, rather a pattern of events whose impacts are difficult to connect.

As such it takes time to bring to the surface the underlying cause and have it widely recognised as a crisis. It takes even more time to convince decision-makers to act.

Climate change is an obvious example of this knowledge-action gap.

For most of its “life” as a policy issue, climate change was perceived as an intangible – hard to define, connect and quantify. It was even harder to convince the public and policy-makers to respond.

Seminal developments over the past decade have changed all that. Scientific consensus, volatile weather patterns leading to observable security, economic and environmental impacts, as well as global awareness campaigns, have persuaded new stakeholders, including the US military and Bank of England, to move into the action camp.

Yet the evolution of climate change as an issue has exposed the least obvious crisis of the 21st century: our system of democratic governance.

It is on the tip of our tongue every time we speak of the difficulties in resolving climate change – our frustration with the lack of future-focused, coherent action. But we rarely articulate it.

So it remains largely hidden – and therefore largely off the agenda for action and change.

In what ways is liberal democracy failing?

Specifically, the failure to tackle climate change speaks to an overall failure of our liberal democratic system to:

• deliver competent, future-focused policy that can guide and give context to the pressing need for action on core challenges

• reconcile expert knowledge and community opinion to deal with the big issues of our age

• gain and sustain long-term consensus on what is often complex policy action to deal with these issues

• achieve effective action by devolving power to local communities or projecting solutions across borders through transnational collaboration.

Climate change is the sharpest manifestation of an entirely new order of policy challenges that confront and confound democracies around the world.

These include cybersecurity, corporate profit-shifting, deepening inequality, porous borders and the movements of people and money that spill through them.

Yet the crisis of liberal democracy remains intangible. This is because we prefer to blame the idiosyncrasies of leaders and bad leadership, rather than the system itself and its growing pattern of policy gridlock and dysfunction.

In the process, we overlook the fact that our delivery mechanism of democracy – liberal democracy – evolved out of a pre-21st century world. It was a world where the speed, scale and complexity of policy were of a dramatically lower order.

So in a globalised, digitally saturated world no longer bound by speed limits, our hands are tied by political and policy machinery, like parliaments, designed to synchronise with the 20th century’s comparatively languid rhythms of decision-making.

In a world of hyper-diversity, this “machine” is engineered to churn out responses to complex challenges within one-size-fits-all templates and packaged slogans.

Moreover, it is largely monopolised by political parties and career politicians. They seek to choreograph the 21st-century policy world with an unimaginative two-step of 20th-century ideologies and allegiances.

Creative coalitions and values that reflect today’s world are, as a result, largely absent.

All this should tell us why the consensus-creating and policy-making institutions liberal democracy relies upon for action and legitimacy risk becoming a case study of failure.

It is also why those who inhabit what is, in effect, an old-fashioned democracy “factory” retreat into the adversarial, the short-term and the sloganistic. These are the blinkers that allow them to shut their eyes to disruption and insist there is no underlying crisis.

What can be done to overcome this crisis?

Successfully tackling climate change and other big policy challenges depends on making tangible the intangible crisis of liberal democracy.

It means understanding that liberal democracy’s governance machinery – and the static, siloed policy responses generated by such democracies – is no longer fit for purpose.

It means coming up with disruptive solutions – like coalitions of countries, cities and companies to tackle climate change – that re-align this machinery with the new order of scale, complexity and speed that defines our 21st-century world.

Long-term solutions to fix the crisis in democratic governance in Australia might include:

• More deliberative systems that directly engage citizens and deepen debate. Such systems would work to capture and grow long-term vision, values and objectives – rather than static perceptions of incremental policy decisions made for tactical reasons.

• Expert and citizen panels that are genuinely intergenerational and cross-sectoral. Their composition should favour younger generations and ensure the baby boomer generation cedes some control over what it leaves to the next.

• Granting more decision-making power to institutions independent of the government of the day, but still accountable to parliaments (such as the Parliamentary Budget Office or Infrastructure Australia). This would increase the capacity of policy planning and decision processes to have staying power beyond individual political cycles.

• Enabling the appointment of some ministers from outside the parliament. This would allow experienced hands – experts at the top of their game – to lead a portfolio while remaining accountable to the parliament.

• Synchronising state and federal electoral terms (to be a minimum of four years), with state and federal elections to take place at two-year intervals. This would allow the meshing of short, medium and long-term planning, complete with clear milestones.

Some of these ideas might work. Some might not. But persisting with a system that seems increasingly incapable of managing the most pressing issues of our age is not an option.

Climate change is symptomatic of, and accelerates, the crisis across our liberal democratic systems. We cannot fix one problem without resolving the other.

Mark Triffitt is Lecturer, Public Policy at University of Melbourne.
Travers McLeod is Honorary Fellow in the School of Social and Political Sciences at University of Melbourne.
This article was first published in The Conversation on 22 April 2015.

 


 

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John Tulloh. Gallipoli: Lest we forget the British promise to the Indians.

 

One hundred years on, many Australians probably still regard the
Gallipoli campaign as an event involving only Australia and, to a lesser
extent, New Zealand. We hear mainly legends, tales of derring-do, myths
and maudlin sentimentality about the Australians who fought there. We
hear next to nothing about the others who also participated in this futile
exercise.

It was, of course, an international campaign led by Britain and
France. They suffered more deaths than the Anzacs. As a German general
commanding a Turkish division observed: ‘Seldom have so many
countries of the world, races and nations sent their representatives to so
small a place with the praiseworthy intention of killing one another’. That
amounted to about 130,000 on both sides.

Little reported among the mix were the soldiers from the Indian
Army. India has every reason to commemorate the Gallipoli centenary
with both pride and anger. Like the others, the Indian troops made a
magnificent contribution in trying to dislodge the Turks. But Britain broke
a promise in the process and literally made India pay for it.

According to the veteran Indian newsman and scholar of modern Indian
history, Prem Prakash, London made a pledge to Mahatma Gandhi
to grant India dominion status in return for rallying support for the war
effort and contributing troops. Gandhi responded enthusiastically because
he saw this as the simplest means to become a dominion within
the British Empire without further ado. It was something he had been
agitating for and which the colonial authorities were loath even to consider.

India contributed 15,000 troops to the Dardanelles. But once World
War One was over, Britain had second thoughts about its promise. Gandhi
had to continue agitating for almost another three decades, including
time in jail, before he got his wish only to be assassinated by a Hindu fanatic.

India’s price for its effort was two-fold. One was a loss of 1358 dead
and 3421 wounded, according to the Australian War Memorial. The other
was getting a large bill from London for its troubles at Gallipoli and on
the western front as well. It paid up.

The Indians were ‘the forgotten soldiers of history’, says Indian military
historian Wing Commander Rana Chhina in his appraisal of Gallipoli.
‘The average Indian is (virtually) ignorant about Gallipoli as a campaign
in World War One’. The same about the Indian involvement can probably
be said about the average Australian. The only known permanent tribute
is a plaque at Ferozepur in the Punjab, from where many of the WW1
soldiers came.

India deployed ‘some of the finest classes of its fighting men at Gallipoli’,
according to Wing Commander Chhina. They included the formidable
Sikh warriors and the ferocious Gurkhas led by British officers.
One officer actually drew his ceremonial sword as he led Gurkhas in a
charge against Turkish positions. Unlike so many of the Anzac troops,
the Indians were all professional soldiers and steeped in the British military
system.

But there was far from unity in the ranks. Some Moslem troops deserted
as they did not see why they should be fighting other Moslems.
Others were exploited by Indian activists pushing the ideal of a pan-Islamic
movement with the aim of international solidarity and unity of all
Moslems. One Indian battalion, the 89th Punjabis, had predominantly
Moslem soldiers and it was felt prudent to divert them from Gallipoli to
France to fight other British enemies.

The Indians fought elsewhere in the Gallipoli peninsula before teaming
up with the Anzacs in August, 1915. There was friendship in their
fraternisation and they often shared food rations. It was said the Indian
roti and daal appealed more to Australian tastes than their standard bully
beef and biscuits.

An important Indian contribution was the Mule Corps. Given the lack
of roads and the hilly and precarious terrain of the Gallipoli peninsula,
motorised transport was out of the question. More than 1000 mules and
10,000 tons of fodder were brought in from India. The mules were used
to ferry supplies. They and their handlers were the unsung heroes, said
Rana Chhina. Just as with the Australian Light Horse animals, the surviving
mules were shot when the Indian troops evacuated Gallipoli in December,
2015. They did not want them to fall into the hands of the
Turks.

Spare a thought also for the 89th Punjabis. They sailed from India in
late 1914 and did not reach home until nearly six years later. They
fought for the British Empire in more theatres of war than any other Allied
battalion. But the reward for them and all other Indians was not
what Gandhi had expected from what he thought would be a grateful
Britain. It proved to be an empty promise.

Prem Prakash says he combed the archives of the India Office in
London to try to find ‘a serious enough reason’ for Britain to have reneged
other than ‘India was not ready yet’. Perhaps it was simply a matter
of the unthinkable: losing control of the strategic jewel in the crown
of the British Empire.

John Tulloh has a 40 year career in foreign news.

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Peter Day. Rather Be Dancing With Me Rosie.

My grandad, he represented Australia; wore a green helmet, too.

Walked out and faced the music: ducked a lead ball, not a leather one, mind you.

Not much of a dressing shed in which to relax and prepare;

A stinking-bloody-trench, sick mates, a smoke, and a ‘God-help-me’ prayer.

Such a long way from home; just seventeen, no one has a clue.

The pollies speak of glory and sacrifice; another teenager’s down … no, not Blue.

No greater love can a man have than to lay down his life for a friend.

That Jesus fella knew a thing or two; just wish me Good Friday would come to an end.

What am I here for anyway; King and country? Is it worth this terrible hurt?

Rather be dancing with me Rosie than going toe-to-toe with a Turk!

Letters from mum, they arrive; bring tears and a smile.

Her words are like a prayer in this foreign land; me home for this next little while.

Come back alive, dear son, I miss you; hope these socks warm-up your limbs.

Things are much the same here, luv; dad’s keeping busy mowing lawns and puttin’ out bins. 

He misses you too, son, but can’t bring himself to write.

Figures time might slow down if you’re on his mind while out of sight.

God, what I’d do to be mowing lawns and playing cricket in the backyard;

Smelling Gran’s scones in the kitchen, and making life for me sisters hard.

I had my future mapped-out: after Uni I’d teach and inspire kids.

Instead, I’m rolling in mud and blood and death; another teen heading for the skids.

“A just war, a waste of life, a sin”the experts all have their say;

Like seagulls squawking ‘round a packet of chips; wish they’d just be quiet and take time to pray.

Pray for our families, our minds; the crippled hearts that no longer feel.

Pray for our enemies, too; what happened to them and their loved ones was also a big deal.

Welcome us home, but not with flags, anthems, chest-beating and the like;

But with silence and humbled hearts, because we all know what just happened wasn’t right.

War is failure. I know that. There’s not much else to say;

Man’s inhumanity to man; may it never again hold sway.

Peter Day is a Catholic Priest in Canberra.

 

 

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John Dwyer. Sliding down the slippery slope to two-tiered health care.

Private Health Insurance gets a foothold in primary care.

Imagine the following scenario. You are checking in with your GP’s receptionist for your scheduled appointment and are asked to produce your Medicare Card and, if you have one, your private health insurance membership card. If you have both you move into the waiting room on the right reserved for patients with private health insurance for whom the practice will provide a range of additional services not available to those in the waiting room on the left.  Health outcomes are resource dependent so patients who can expect more quality time with their doctor and a range of services from other health professionals because private health dollars make it possible will, in many cases, have better outcomes. This is particularly likely if they are troubled by chronic and complex conditions. In such circumstances it’s also not hard to imagine practices over time, deciding to accept only patients with private insurance, as is commonplace in the US.

Unlikely scenarios for Australia? I hope so but certainly don’t know so and recent developments convince me that both health professionals and consumers need to be pro-active in making it clear to our politicians that such discrimination would be totally unacceptable. There is already much in our health system that is unfair and expensive. Unfair in that increasingly timely access to quality care is often determined by personal financial wellbeing rather than need, and expensive in that inferior care to socio-economically less privileged Australians results in much chronic disease that eventually costs the taxpayer dearly. As we struggle to reverse that situation we have, for the first time, an Australian government encouraging private health insurers  (PHIs) to become involved in our primary care space. Four of the successful tenders for the operation of the 31 new Primary Health Networks (PHNs) will utilise consortia involving for profit and not for profit private health insurers.

Labor’s “Medicare locals’ have morphed into the Coalition’s Primary Health Networks. The health minister has explained that this new initiative will see PHN’s co-ordinating care offered by local hospitals districts (of which there are more than 150 in Australia) and local GPs. The networks are not to provide health services directly but use their 900 million dollars to “improve front line services”.  Currently private health insurers are not allowed to offer additional insurance for any services funded by Medicare. However there is every chance that Insurers involvement in PHNs, which will include input into GP training, and workforce planning, could be the start of an ever-larger role for private insurance in primary care.  At the time of the PHN announcement a spokesman for the peak body for insurers, “Private Health Care Australia”, said, “the best way to improve Australia’s health system is to increase the role it (PHI) plays in GP care”.

While the new initiative is unlikely to be any more successful than its predecessor given the vagueness of the terms if reference and the small number of networks covering a huge country yet asked to act locally, the conflict of interest that is inherent in having PHIs involved is very real. PHIs primarily exist to benefit their members, by and large better off Australians while PHNs to be successful must target better services for less advantaged Australians.

Global experience tells us that these networks should indeed be subdivided to become locally relevant and offer model Integrated Primary Care and secondary services. They should play a “hub” role for affiliated practices helping with IT, documenting health outcomes, continuing education, bulk purchasing, in house drug education, research etc. etc. About as different from what is on offer as is possible to imagine.

Why are PHIs so keen to get involved in Primary Care? While business models involving large numbers of Australians buying primary care insurance may be attractive the main reason for PHIs interest in primary care is their need to have fewer members admitted to hospital. This is particularly important for those admitted frequently as a result of advanced disease. Our larger PHIs tell us that 5-10% of their members who are frequently admitted to hospital generate 50 -60 % of their costs. Better-resourced primary and community care for these members might reduce admissions and save them large amounts of money. The political and public relations dilemma is easy to understand. How can they provide their member’s primary care team with the needed resources without creating a two-tiered system?

Of course the exact same problem, though on a much larger scale is troubling, or perhaps more accurately, should be troubling Australia’s national insurer. As has often been discussed in these blogs it is public hospital care and associated costs that are consuming most of our health care dollars, not Medicare.  With our State/Federal divide in health care responsibilities it is State budgets that are in the same boat as the PHIs, ever increasing numbers of older and sicker patients requiring hospitalisation.  A number of studies have found that as many as 600,000 admissions to public hospitals could be avoided annually if our primary carers were resourced to offer better community care.

We hospital doctors know only too well that many of the patients who return to hospital frequently have such advanced disease that little can be done in the community to manage their recurring crises . We certainly know that many such patients will die in hospital when a better death with more dignity at much less expense is not available at home. But the real challenge is to develop a primary care system that reduces the tsunami of Australians who are at risk of developing Chronic and Complex conditions and do so.

Is there a role for PHI in the creation of such a system? Certainly PHIs can and often do help their members with resources to improve their health literacy and their understanding of how they can best help themselves to manage their problems. Many in the private health industry are enthusiastic about the “Medical Home” model of care that I, and others, have described enthusiastically in detail herein the following link. http://johnmenadue.com/blog/?p=3192    Some insurers have expressed interest in funding “proof of concept” practices resourced to offer the Integrated Primary Care (IPC) that is at the heart of the Medical Home model. There is proof from many countries that this model does very significantly reduce hospital admissions. Our federal government should be even more interested in this model as the majority of hospital admissions involve people without private health insurance. Canberra not the PHIs should be establishing Medical Home practices to demonstrate the benefits of the model in Australia. Some in the private health insurance industry have called on government to join them in supplying our primary care system with resources that emphasise prevention, early diagnosis and management of potentially chronic problems and care in the community for many currently sent to hospital. It is hard however to envisage a mechanism for such cooperation.

International experience warns us of the many problems associated with a mix of public and privately funded primary care. We do not want insurers (be the private or public) interfering with decisions about treatment programs for individual patients. We do not want a two-tiered system. On balance we should be urging government to maintain the current restrictions on PHI supplementing Medicare funded services. In so saying we should immediately add that Medicare does need a major structural overhaul to become a funder of a primary health care system not a fee payer for doctors.

The health minister has indeed just announced a review of many aspects of Medicare. The review will be led by two good people, Dean Bruce Robinson from Sydney University and Dr Steve Hambleton a former head of the AMA. The minister’s statements suggest that she feels that our current model of primary care would be fine if over servicing, rorting doctors and low value test and procedures were contained. The reviews will take 18 months and to encourage GPs to participate the current freeze on cost of living adjustments to Medicare rebates will remain until efficiencies are providing extra dollars. No talk of PHI involvement and no talk of Integrated Primary Care!

In reality we don’t need more reviews asking, “what should we do?” but rather a health care reform commission to drive changes (“how do we do it?) that are evidence based providing us with a cost sustainable and fairer health system detailed in these columns on any number of occasions.. The result would be a generation of healthier Australians with government and PHIs spending far less on expensive hospital care. A real “win, win” situation.

John Dwyer is Emeritus Professor of Medicine at UNSW. 

 

 

 

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Walter Hamilton. In the Name of the Emperor

Emperor Hirohito never made it to Okinawa. He passed away before he could fulfill that stated desire. (He was scheduled to go in 1987, until illness intervened.) Okinawa was the scene of some of the most savage fighting of the Pacific War: 100-200,000 Japanese soldiers and civilians died there in April-June 1945, as well as 14,000 Americans.

The Okinawan or Ryukyu Islands were annexed by Japan in 1872 during the reign of Hirohito’s grandfather, the Emperor Meiji. Ever since, the islands’ ethnically distinct people have remained stuck at the bottom of Japan’s socio-economic ladder; Okinawans endured disproportionately heavy sacrifices during the war, and continue to do so.

Once the Americans handed the islands back in 1972 (less the vast tracts of real estate occupied by U.S. military bases), Hirohito had 17 years to make the trip south. His son, Akihito, went as Crown Prince and would visit Okinawa a further nine times after acceding to the Chrysanthemum Throne. But Hirohito––who went to every other prefecture in the nation during his long reign––never made it.

Were there political forces keeping him away? Could it be that conservative governments in Tokyo, and their patrons in Washington, feared a Hirohito visit would become a rallying point for opponents of the Security Treaty? Most Okinawans oppose the heavy American military presence in their midst, so what would they think of the emperor who effectively put it there?

Earlier this month Emperor Akihito and Empress Michiko made a well-publicised trip to the western Pacific, carrying on where Hirohito almost left off. They went to the island-state of Palau to pay their respects to those who perished in the Battle of Peleliu in September-November 1944 (the distinguished Australian cameraman Damien Parer was among the many thousands killed on that speck of land).

The trip was a considerable undertaking for the Imperial couple: he is now 81, and she is just a year younger. It also carried potent symbolism: in the dignified and modest way in which the frail Emperor and Empress conducted themselves; in the fact that they ventured to another country––Palau is now independent––to draw attention to the terrible costs of war; and in the emphasis placed, in their remarks, on the sacrifices made by both sides in the conflict. This was no chest-beating exercise; it was a voice of reason, humbly reminding Japanese of the true legacy of their past.

None of this symbolism was lost on the Japanese public, at a time when Prime Minister Shinzo Abe is pushing a revisionist view of history by downplaying or denying some of the worst aspects of the nation’s past militarist adventures. The New York Times editorialized on 20 April:

               Mr. Abe’s nationalist views and pressure from competing political forces have affected  his judgment on these delicate issues. He has publicly expressed remorse for the war and  said he will honor Japan’s past apologies for its aggression, including the sex slavery. Yet  he has added vague qualifiers to his comments, creating suspicions that he doesn’t take  the apologies seriously and will try to water them down.

His government has compounded the problem by trying to whitewash that history. This  month, South Korea and China criticized efforts by Japan’s Education Ministry to force  publishers of middle-school textbooks to recast descriptions of historical events —   including the ownership of disputed islands and war crimes — to conform to the  government’s official, less forthright analysis. And last year, the Abe government tried           unsuccessfully to get the United Nations to revise a 1996 human rights report on the  women Japan forced into sex slavery.

Japan’s Imperial family, many believe, is acting as a bulwark against Abe’s retreat from responsibility and as a restraint on his government’s ambitions for an enhanced military capability and more assertive posture towards China.

At a news conference in February, Crown Prince Naruhito, the heir to the throne, was asked for his views ahead of the 70th anniversary of the end of World War Two. He replied: “I myself did not experience the war… but I think that it is important today, when memories of the war are fading, to look back humbly on the past and correctly pass on the tragic experiences and history Japan pursued from the generation which experienced the war to those without direct knowledge.”

The key words are “humbly”, “correctly” and “tragic”. In a country where the sovereign (or, in this case, the sovereign-to-be) is expected to remain strictly apolitical, this was as near as one gets to a public reprimand.

Prime Minister Abe has a special “panel of experts” preparing to advise him on the public remarks he will deliver on 15 August when the nation commemorates the war anniversary. Next week, in Washington, where he is set to become the first Japanese Prime Minister to address a joint meeting of the U.S. House of Representatives and Senate, many expect to hear a preview. The New York Times commented that, apart from progress on defence cooperation and trade,

 the success of the visit also depends on whether and how honestly Mr. Abe confronts  Japan’s wartime history, including its decision to wage war, its brutal occupation of China and Korea, its atrocities and its enslavement of thousands of women forced to  work as sex slaves or “comfort women” in wartime brothels.

Australians, fresh from their commemoration of an earlier conflict, should also be attuned to the Japanese leader’s take on history. As will the Imperial family, which has made it clear it will not allow its prestige to be appropriated for any future acts of belligerency. Should Abe during his U.S. visit resort to “weasel words” about the past, there is an octogenarian monarch waiting in his palace who may be prepared to call him out.

 

Walter Hamilton reported from Japan for the ABC for eleven years.

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John Menadue. Commercialisation and the Casualness of Going to War

If we feel overwhelmed by the crass commercialism of Gallipoli and Anzac, take a deep breath because there are three years to go.

Target has sponsored ‘Camp Gallipoli’, Woolworths has asked us to ‘Keep Fresh in our Memories’ the losses of Gallipoli ; VB depicted for us actors on the steps of the Melbourne Shrine of Remembrance who  tell us to bow our heads and raise a glass of VB in memory of the first Australians who charged and died at Gallipoli. There have been endless advertising and sales of Gallipoli kitsch. Even our Governor General a few years ago fronted at the hotel bar for VB to raise a glass and  money for veterans.

But the slipping TV ratings suggest we are getting tired of the saturation media coverage and the $400 m spent by the Australian Government on a whole range of Anzac ‘educational’ programs.

When the myth making all started in 1915 Charles Bean, the official military historian carefully burnished the Anzac myth. Soldiers were strong, adaptable, cheerful, laid-back, but faithfully serving the empire. Not for Bean the harsh realities of war unless they were laced with humour. He didn’t tell us much about the fear, desertion or boredom of soldiers far from home or the horror of it all. He was gilding the lily about the terrible nature of the war in which young Australians were killing and being killed.

The last surviving Anzac, Alec Campbell said in 2002 ‘For God’s sake don’t glorify Gallipoli..it was a terrible fiasco, a total failure and best forgotten’. But the Anzac obsession continues.

To burnish the conservative interpretation of our military history we, and particularly the Australian War Memorial, are very selective about the story we tell. We have selective amnesia. We ignore the Frontier Wars, a race war by white landowners in which over 30,000 indigenous people were killed defending their homeland. In proportion to our population it was the largest loss of life in war in our history. But there is scarcely a grave or a memorial to remember the people who died in the Frontier Wars. Our first military alliance with New Zealand was not at Gallipoli but in the Maori race wars in the 1850s and 1860s.

Best we forget the Frontier and Maori Wars.

We choose to make WWII almost a footnote to our military history, but it was far more important to our survival than any other foreign war.

Old soldiers will scarcely ever tell us about their experiences. They were haunted for years with the horror of it all. But today we don’t seem able to stop talking about Anzac and Gallipoli. We have seen so often on TV a long-lost cousin or a great uncle that has been forgotten. It seems more like sentimentality than grief.

The careful selection of people and events by Bean diverted attention from the enormous political, strategic and personal tragedy of Gallipoli. We do the same today. We are encouraged to forget the blunders we made as a nation, involving ourselves in wars in Vietnam, Iraq and Afghanistan. Like Bean, we divert attention by focusing on the sacrifice and losses by ordinary servicemen and women. We seem to turn ourselves into a knot to avoid facing the history of our military blunders. The same process is now under way with our expanded commitment to Iraq. What we will not acknowledge is that there was no national interest in sending Australian troops to Gallipoli just as there is no national interest in sending troops again to Iraq.

On Anzac Cove Tony Abbott has told us that our involvement at Gallipoli was ‘right and just’. Others talk of ‘defending freedom’. In my view none of these claims stand up to serious scrutiny.. We were there for the empire.

The Bean myth-making was essential for conservatives to divert attention from the military, political and personal tragedies; the division at home over conscription; the sectarianism of Billy Hughes and the poverty and unemployment in the great depression. It was not a land fit for heroes. WWI sundered our nation and it wasn’t until 1945 that we really started to put it together again..

There are two bookends in our celebration of our military history. They are out dependence on the UK and the USA. We try to invent reasons why we fought at Gallipoli, but I have yet to hear a believable account of what we fought for there, except serving the empire. At Gallipoli Australian soldiers flew the Union Jack.  Today we also try to invent reasons why we are fighting in Iraq, but the real reason is the call of the latter-day imperial power, the USA.

How can we possibly believe that Gallipoli and Iraq is about nationhood? Our involvement in both was for quite opposite reasons – serving the empire. Unfortunately some people believe that nationhood, like manhood can only only be proven in war and violence.

My main concern about the Gallipoli myth-making and our military history is because it is pushing us steadily further and further down the military path. Our foreign policy has become overwhelmingly militarised. Combatting asylum seekers in Operation Sovereign Borders is an example of how civil policies and programs are being turned over to the military. We are again appointing military generals as governors and governor generals.

This militarisation of Australia has contributed to making our involvement in wars a quite casual event. The latest addition of 300 Australian service people to Iraq scarcely raised any attention at all.

Taking a country to war used to be considered the most serious step that any government could ever take. But no more. The parliament doesn’t even debate a new overseas commitment. In an almost unthinking way we decide to go to war again. We commit to war after war and then refuse properly support returning service people.

As Henry Reynolds put it

‘The threshold Australian governments need to cross in order to send forces overseas is perilously low. Because there has never been an assessment of why Australia has so often been involved in war, young people must get the impression that war is a natural and inescapable part of national life. It is what we do and we are good at it. We “punch above our weight”. War is treated as though it provides the venue and the occasion for Australian heroism and martial virtuosity. While there is much talk of dying, or more commonly of sacrifice, there is little mention of killing and never any assessment of the carnage visited on distant countries in our name.’

In Australia today it is becoming much easier to go to war. War is becoming commonplace and the celebrations surrounding Gallipoli make it more so. Step by step we are moving into very dangerous territory, something that the diggers of Gallipoli or the Western Front would have warned us about. It was so horrible; they didn’t want to talk about it. But we talk about it endlessly.

We should behave with restraint and put some of the drums and bugles away. Let’s pause and think what we are doing.

The lesson of Gallipoli must surely be to avoid making the same mistake again…whether it be in Vietnam,Afghanistan or Iraq.

 

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John Menadue. The price we are paying for the Greens.

The recent successes of the Greens in state elections in Victoria and NSW show us how populist nonsense can succeed at least in the short term. It has also shown the failure of the ALP to counter the threat of the Greens.

There are two major issues on which the policies of the Greens have brought disastrous results for Australia. When it really mattered on climate change and asylum seekers, they sided with Tony Abbott.

The Greens literally shed tears over the plight of asylum seekers. But they must bear a heavy responsibility for what we now see on Manus and Nauru.

In the Senate the Greens sided with Tony Abbott against the arrangement with Malaysia, which, whilst not ideal, would have been a useful first step in curbing boat arrivals. That arrangement with Malaysia was negotiated with the understanding and broad support of UNHCR. Not only did the Greens side with Tony Abbott opposing amendments to the Migration Act to allow the arrangement with Malaysia to proceed, they embarked on an unscrupulous bashing campaign of Malaysia.

With the collapse of the Malaysian arrangement boat arrivals in Australia increased dramatically. The result was Manus and Nauru. The Greens cannot be absolved for their populism and the consequences we now see on Manus and Nauru.

The Greens must also accept major responsibility for the collapse in public support for effective action on climate change. In collaboration with the Coalition in the Senate they opposed the Carbon Pollution Reduction Scheme of the first Rudd Government. If the Greens had supported the Rudd Government’s CPRS in the Senate, the issue of climate change would not have been fully ‘done and dusted’ but we would be in a far better position on climate change than we are today. As a result of the Greens joining with Tony Abbott in the Senate we have no Emissions Trading Scheme, no carbon tax and a fig leaf of a policy called ‘Direct Action’.

The Greens have inflicted disastrous damage to Australia on both climate change and asylum seekers. Their sabotage on both has set back real reform and decent policies.

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John Menadue. Drownings at sea.

The recent tragic loss of 800 Libyans in the Mediterranean has given once again an opportunity for the Government to infer that Australia’s refugee policies are designed particularly to stop people drowning at sea.

It is self-deception or worse for the Government to suggest that its policies towards refugees have been motivated by humanitarian concerns and not political advantage. Perhaps with guilty consciences self-deception is necessary.

In Opposition the Coalition was not interested in stopping the boats to save people drowning at sea. Its political objective was to stop the Labor Government stopping the boats. That is why the Coalition with cooperation from the populist Greens voted in the Senate against amendments to the Migration Act which would have allowed the Malaysian Arrangement to proceed and curb boat arrivals, in cooperation with UNHCR. By frustrating the government, the Coalition showed no interest in stopping drownings at sea.

On 10 December 2010 the SMH reported from Wikileaks that ‘A key Liberal Party strategist’ had told a US diplomat in Canberra in November 2009 that the issue of asylum seekers was ‘fantastic’ for the Coalition and ‘that the more boats that come the better’. With such a cynical approach, it’s hard to see much concern for innocent asylum seekers who might drown at sea.

Scott Morrison told us on many occasions that asylum seekers bring disease, everything from TB to Hepatitis C, to Chlamydia and Syphilis. He told talk-back radio that he had seen asylum seekers bring wads of cash and large displays of jewellery. He urged the Coalition to ramp up its questioning … to capitalise on anti-Muslim sentiment. Does that sound like genuine concern for the lives of asylum seekers?

Scott Morrison and Senator Abetz both called for the registration of asylum seekers moving into residential areas on bridging visas, just like paedophiles. Does that sound like genuine concern for asylum seekers?

To provoke hostility to asylum seekers, Tony Abbott and Scott Morrison both continue to call asylum seekers ‘illegals’. They hope that we would think that asylum seekers were akin to criminals. That didn’t show much concern for the rights of asylum seekers.

The Coalition’s campaign to demonise asylum seekers was overwhelmingly for political reasons. They succeeded.

But please spare us the propaganda of suggesting that the Coalition’ policy on refugees was to stop drownings at sea.  It was not. It was crass and cruel politics.

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