Politics is broken

Politics ~ the threats to democracy and aged care

It must be clear to anyone who has been listening and looking over the last few years that politics is not working and that the political process is out of control.

Instead of a humanitarian mission dedicated to serving the public, it has become a no holds barred competition to gain power in which almost anything becomes legitimate. Policies are advertised and marketed like any other commodity, rather than discussed and analysed.

This would not matter too much for aged care if it had not been made a pawn in the battle, and a victim of misdirected ideology. But to understand what is happening in aged care we need to understand what has happened to politics and democracy. It is a long time since health, aged care and other community welfare projects were sequestered and protected from the political fray.

Summary of this page

The first slider on this page takes a broad look at politics and why it is broken. I quote from eminent lawyers, academics who have studied politics internationally, the Australian Institute, the Swinburne Institute for Social Research. Critically, I look at the what, how and why our political system is in such a dire state. The page explores politicians misconduct and corruption quoting a human rights lawyer - and a number of other issues.  Links allow you to explore in greater depth.

The second slider looks specifically at the interface between the health and aged care systems and politics to illustrate problems there. It looks at the major barriers to health care reform including the way the government buried aged care, the liberalisation of pharmacies, Competition policy, and political lessons that can be learned from recent legislation in the USA.

The third slider looks at the implication of the globalisation of health and aged care in trade agreements.

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1. Politics generally

In this slider section I look at what Judge Tony Fitzgerald, academic Joseph Camilleri, Rob Oakeshott and others say is happening in politics and in how the country is being run.

Democracy under threat

As revealed in the outcry about appointments to corruption bodies and to the judiciary in Queensland, many judges are intensely concerned for our democracy and the direction politics is taking in Australia - but there is a tradition that judges remain above politics and do not speak out.

The situation is clearly so dire that two of our most respected judges, Tony Fitzgerald and Gary Crooke have twice spoken out. Twenty-five years ago they conducted the investigation of the corrupt Bjelke Petersen government in Queensland - so they know just how bad things can get. The chief of police and several government ministers went to prison for a long time.  Another died before he could be convicted.  The judge's criticism is not of any particular party but of the direction that both major parties have taken.

They first spoke out in 2009 when labour were in power.

Clearly as lawyers and judges, Fitzgerald and Crooke are concerned about the potential for corruption and the failure to act for and protect citizens. They went so far as to challenge governments to commit to four democratic principles, which they did - but it seems that this has had little impact.

In January 2015, Fitzgerald was talking about those principles when he said this:

It is interesting that Fitzgerald sees part of the problem as lying in public perceptions and he is pleading with the public to take the matter in hand and put pressure on politicians. He realises that politicians are unable to help themselves and still remain competitive. This is very similar to what has happened to public perceptions of aged care and to aged care policies. This is why I am urging the public to get involved and am proposing the hub as a means of doing this.

Perhaps, contrary to the claims of both major parties, a hung parliament would best serve democracy - if it were allowed to work in a democratic way.  Tony Windsor and Rob Oakeshott, both responsible and experienced politicians, believed that the hung parliament in which they supported the Gillard labour government was a golden opportunity to restore democratic government.  They tried hard, but were drowned out in the rhetoric and when politicians "took the money and ran". 

The only restraint on government excesses today is when minority parties hold the balance of power in the senate.  They are from splinter parties, often inexperienced with unusual platforms and ill equipped; yet they have been surprisingly effective. As Fitzgerald realised that politicians themselves could restore effective democracy is probably a pipe dream.  The community has to find a way of doing that.

I also argue that sensible competition, which drives many of us, has also become an ideology. As an ideology, it is seen as an unchallengeable good, its negative impacts are simply not acknowledged and it is no longer used sensibly. This is readily apparent to anyone who is not blinkered when we look at what excessive competition has done to politics and to aged care. It needs to be modulated and controlled by society. This is what the proposed hub might contribute to by doing so in aged care. 

Competition is about winning and not losing. When competition is uncontrolled politicians paint themselves into a corner and are unable to get out of it without losing.  Our community has blindly followed the irrational belief that competitionis is somehow enclosed in a halo.  They are consequently blind to the problems caused by uncontrolled competitiveness in politics.  We need to be more sensible and the community is better placed to do this.

Aftermath:  Many of us in Queensland watched the Newman government do all those things Fitzgerald was worried about, and the electorate had been misled on.  They went so far that, in spite of their landslide election, the electorate threw them out at the first opportunity.  There are now attempts to undo some of the harm and prevent it from happening again.

Not for profit advocacy group, Queensland Advocacy Incorporated has called on the new Palaszczuk Government to urgently introduce a Human Rights Act in Queensland: 

A Human Rights Act would enable citizens who are aware of the adverse consequences of innapropriate government actions to use the courts to restrain harmful political excess.

Democracy in crisis

In a recent article "Democracy in Crisis" in The Age, Joseph Camilleri, a professor at La Trobe and a distinguished social scientist who has studied politics and international relations, closely examines what has happened to democracy and the broken political process in Australia. He is particularly interested in the way global issues have contributed to this and the need for civil society to start addressing the issues and then become global itself.

Aged care is trapped in this system and is a part of the international problem. This article is well worth examining as it contributes to our understanding of the difficulties in getting politicians to engage constructively with the community and of the pressures that render them ineffective. Addressing the problems in age care is just one step towards resolving the bigger problems but it is a good place to start.

There is always inertia in starting a process and you have to push hard. But you have to start somewhere and once it starts rolling the easier and faster it goes. As the other links below show, The Centre for Welfare Reform in the UK has started pushing.

Let's join in and play our part. The extracts below give the flavour of the article:

Running the country like a business

An article in the Canberra Times from the Australian Institute compares the way politicians are running our country to a big business. The article claims that this is what government is trying to do. They are taking advice from the market in order to do so. The argument made is that, as a business, government is managed very badly and illegally. Shareholders would sack them.

The article also argues that you cannot run a country like a business. The patterns of thinking required are different. It gives examples. Its a simple message and a simple metaphor, but worth a look:

I argue in relation to aged care on my own website, Solving Aged Care (Looking Differently) that different sectors may require different operating contexts. These should be ones that encourage suitable patterns of thinking for that sector, foster characteristics that are required and select for the sort of people that are needed to make the sector work well. Neither politics nor aged care are doing that.

As is clear from Fitzgerald's ABC 7.30 interview, we have a political context that does the very opposite. It fosters unwanted characteristics and selects for the least suitable people. But these web pages are about changing the context in aged care not in Canberra.

I simply want to show that the two are intertwined and the underlying problem is very similar. Addressing aged care can be seen as a first small step to rebuild society starting at the bottom, which is the right place to look at problems and see what is happening. We want politicians who will work with us in our lives and then build policy with us from there. Democracy is primarily about people and their lives - not ideology - and that is how it should work.

Hiding policies and planned implementation from the public: Now it just so happened that soon after I had written this I briefly turned on the television and heard a presenter analysing the Howard years. He told us more about how politics was being run as a business.

As I recall, the presenter was explaining how Howard had kept critical issues out of the public eye and off the headlines by not talking about them and not telling the public. Abbott, he claimed, had adopted the same strategy, and now that his leadership was under threat he would be even more careful to do that. He approved of that as the correct political strategy.

Now what does deliberately not informing the public about how you are running the country say about our democracy and the way politics works? And worse still - what does it say about the person speaking (I think it was a journalist but it may have been an opinion being aired) when they approve of this and don't criticise.

Currently Abbott and his ministers are forcefully saying the very opposite claiming that they are going to be more open and consult with the public. Can we believe them? Will they be consulting and listening or will they be selling themselves and persuading? 

In Part 5 on this web site I talk about what I call "culturopathy" (deeply held beliefs that justify actions and activities that are harmful) and this sounds very much like it.

When you look at what has happened in aged care reflect on what has happened. Look at how Howard worked with the industry to reform aged care and managed to keep key issues like the abolition of the probity regulations and the removal of all effective oversight and evaluation of standards of care out of the pubic eye. Labor later played follow the leader.

Consider the way in which the Abbott government has worked with the industry dominated, organisation NACA. They have developed strategies to reduce oversight, to hand complaints resolution over to the providers that are being complained about, to develop and implement the (optional) self reported quality indicators, and introduce Consumer Directed Care, all under the close control of the industry rather than the community, most of whom are kept in the dark.

NACA (National Aged Care Alliance) is an industry-dominated body whose members are barred from criticising decisions they might have disagreed with during discussion. Those in NACA who had examined all the issues and disagreed with the majority decision would not have been able to inform us of their contrary views and contribute if there had been community debate.

Consider whether any of them really discuss the issues with us openly - or do they simply try to sell the idea to us in glowing terms once decisions are made? How much of this is due to an excessively competitive political system?  Has it forgotten its democratic role and is it now actually destroying our democracy?

When policies are based on illusions and are coming apart then every effort is made to control information and prevent public debate. Scott Morrison did this in immigration and again when he was in charge of social services.  An article in the Canberra Times explores this.  In a world that uses words to accurately describe things this is called censorship!

If Abbott was being advised by business, he would do all of the planning in head office behind closed doors, muzzle criticism, prevent leaks, and then hire a public relations firm to sell the product making it sound as attractive as possible.

This is how all the big health care corporations that misused vulnerable people to make vast profits in the USA behaved.  That seems to be very like what is happening in politics.  These companies believed in what they were doing and many could not accept that they were doing anything wrong, even after pleading guilty to criminal conduct, or paying massive civil settlements. Can we reasonably draw parallels in our politics? Is this a human pattern of behaviour that manifests in many different places and guises?

Closing down Freedom of Information (FOI): An excellent article Closing down FOI: a case study in sneaky government published by The Conversation on 5 Oct 2015, describes the way in which the Abbott government effectively in 2 years destroyed 3 decades of the movement towards more open government. The federal FOI system had been revised and upgraded between 2008 and 2010 making it more effective.  The article is well worth reading.

After attempts to shut down the Office of the Australian Information Commissioner (OAIC) failed and the Bill to remove its funding was blocked by the Senate, the Abbott government still succeeded in slashing OAIC's funding. Two Commissioners have resigned as a result and no one has been appointed to replace them. It has been effectively castrated.

The article describes this as “so tragic and frustrating”.  It indicates that “The information access momentum that had been building since 2007 came to a grinding halt- - “.

The new Prime Minister, Malcolm Turnbull, has promoted a policy of open government but the Bill removing funding has not yet been withdrawn. It will be interesting to see if it is and if the OAIC is now funded and gets a new Commissioner. That will be a test of his integrity.

Abbott’s conduct was in the face of an international trend to far more open government. There is a new international “Open Government Partnership” (OGP) something to which Australia committed itself to “in principle” in 2010. The OGP has repeatedly asked for Australia’s decision but Australia has stalled and now “risks joining Russia as the only candidate member to withdraw from the OGP”.

So far 66 countries have signed up. Will Turnbull sign up? Australia stands out in bright orange as an exception that is not progressing much on the map on the OGP website.

The Open government Agreement - yes Turnbull will (Added December 2015): Belatedly, perhaps because a deadline was approaching and Australia, a founding member of the movement would have looked ridiculous had it reneged on the undertaking it gave in 2010 to sign up to and commit to the global Open Market movement by 2013. It would probably have been the only country to have done so. Its claim to be a world leader and player on the global stage would have been in tatters

Turnbull would have been in an embarrassing position when he met many of these leaders on his first trip overseas. The process was opened for public debate by the department of prime minister and cabinet while he was away.

This Open Government movement is part of a 21st Century initiative which Australia embarked on in 2007 when it initiated FOI legislative reform. The Abbott government then took us back into the 20th century reversing all the gains.

The government is asking for advoce and opinion but is keeping it very low key.  I urge as many readers as possible to look at the Open Government section on the page “Developments in Social thought” where there will be more with links to the feedback pages.  There are people in society who have been pressing for this. 

I don't think politicians really want to know what Australians think because they don't want to go that way - so lets make sure we tell them.  I found a blog by a supporter that  tells the story

• PM Turnbull on the road - an opportunity to stand with the Open Government Partnership Peter Timmins’ Blog 11 Nov 2015

An Orwellian article: It is interesting to read an article Consumers are the 'great reformers' and don't want to be told what to do or how to behave by the treasurer, Joe Hockey, on Business Insider 26 August 2015. It was an edited extract from a talk to The National Reform Summit. An election is looming and in the article Hockey lays claim to the sort of community participation that the party is so strongly criticised for not providing. He makes exaggerated claims even coining the term “consumer sovereignty” welcoming and supporting this and calling it great news. He mentions health and aged care.

I am reminded of impressive letters to NSW Health Department in 1993 by a US health care company called NME. In response to allegations about its conduct NME made exaggerated claims to the very opposite without actually addressing the allegations made. The letters were so assertive and so impressive that the authorities believed them. It was not until NSW received damning evidence that they took action. The company was eventually forced out of Australia but not by NSW.

In writing about the company and objecting to its presence in Australia I coined the term “NMEspeak” to draw a parallel with George Orwell’s “newspeak”.

The difference between NME and Hockey is that NME’s own internal documents said the same things. They actually believed all this because they lived in an illusionary world and were blind to what they were doing. Did Hockey believe too? On this occasion Hockey was speaking to converted businessmen. Would the public have been as impressed if they had been there and would they have put him right?

Factionalism in politics

Factionalism has plagued the Labor party over the years and the coalition have capitalised on this very successfully. An article in Inside Story, a publication from the Swinburne Institute for Social Research, documents this and then examines factionalism in the liberal party. There is much to suggest that this has had a far greater impact on Australia than we realise and is largely responsible for pushing our political process into a blind corner from which neither party can escape.

The article compares the moderate liberal faction in Victoria, which dominated the party and adopted a social compact and a mixed economy that was never wholly accepted in New South Wales where a more radical free trade movement originated in the 19th century. The Victorian liberalism proved to be more popular in the electorate. Fraser was the last of the Victorian premiers. Under Howard and Abbott NSW right have prospered and dominated the liberal party. The article The Liberal Party’s faction problem published on 6 July 2015 is worth reading.

As I see it, Howard and Abbott have aligned Australia closely with similar ideologies in the USA and the UK and become strong advocates for free “liberalised” global markets and leaders in this program. Having Australia in a high profile position and involved in international military adventures with these close allies has in my view made it difficult for any other party to move in another direction without destroying Australia’s position, so leaving labor without a viable election platform.  Rudd's success in 2007 was also a backlash against Howard.

Unfettered free markets have never appealed to Australian citizens and this is why the NSW faction had languished. Howard was particularly skilled at keeping debate focused on what he wanted and keeping contentious issues out of sight at a time when labour lacked credible leadership.

Abbott has not displayed the political skill and the electorate are now more aware of what is happening. With labor unable to develop plausible alternatives, politics is paralysed and Abott's policies very unpopular. Conduct has degenerated into a Punch and Judy show and debate to catchphrases and slogans. Aged Care is trapped in this.

"Bribery" in a failed political system

In Part 1: How do we solve aged care? I quoted from Rob Oakeshott's criticism How big business hijacked parliament. This described the way governments depend on big business for money and media support so give those who have money and control of the media what they want. That is worth reading. Oakeshott has experience in state politics and was also one of the independent federal MPs who held the balance of power in the Gillard hung parliament.

It is sometimes worth looking at more radical critics of our democratic system, even when we don’t agree with their solutions.  They can see our problems more clearly than we do. The quote below is extracted from an extract I saw published separately recently.  It was taken from a book by David Graeber who teaches anthropology at the University of London and is a professor in the London School of Economics’ anthropology department.  He is very critical of our system and the changes he proposes are radical. Although he is referring to the USA, he explains how the lobbying system and financial bondage that Oakeshott is so concerned about works. He describes this as bribery, masked by using words that make it sound legitimate.

In Australia, Doug Moran claimed to have written most of the Howard governments 1996 aged care policy and NACA seems to be the body that now advises and helps the government make policy.

Oakeshott wrote an additional piece on Crikey prior to the NSW Election.  In this he looked at the dynamics of the election process. This is one of a series of articles about the NSW election and health care on this blog. At the time it looked as if the new government was very unlikely to have a majority in the NSW Upper House so would not be able to pass the laws and implement its electoral policies.  Oakeshott is critical of the way in which politicians in the present system are forced to sell policies to the public and pretend they will not compromise. This is unrealistic and contributes to the political paralysis and community frustration that the country suffers from.

(Note that Mike Baird eventually won control of both houses so this situation did not eventuate.)

Politics, money and corruption

Politics and the Mafia: In “Drugs Murder and Politics” the first of a two part series “The Mafia in Australia” ABC Four Corners shows how the Mafia were able to infiltrate Australian politics and allegedly used donations to the liberal party to find favour in the party and induce Amanda Vanstone to allow a prominent member of the Italian Mafia into Australia. His request had been rejected by a previous minister. The consequences are revealed in the second part of the series, Blood Ties.

Politicians and entitlements: Everyone will be familiar with the recent snout in the trough scandal which forced speaker Bronwyn Bishop to resign. This opened a can of worms as politicians across both major parties were found to have indulged in similar practices. These were not strictly illegal. They were not only wide of our community’s expectations, but unacceptable by any standards.

Jeff Sparrow writing for ABC news We’re right to maintain the entitlements rage on 11 August 2015, compared the way politicians were gouging the taxpayer while taxpaying citizens were being treated ruthlessly and with arrogant disdain by their these politician’s business constituents and supporters and poor sections of the community struggled as a consequence of their policies.

Criminality: If politicians can be so gullible and so easily feel they are entitled to dip into taxpayers money for themselves, then we need to ask how readily they will as individuals and as political parties come to accept bribes for supporting policies and not see that as wrong. Will they find ways of looking the other way. We know what happened in conservative politics in Queensland under the Belke Petersen government in the 1980s. We have the more recent criminal activities involving labour politicians in NSW and some evidence to suggest that liberals were not too far behind.  Craig Thomson's corruption in embezzling funds from a trade union caught up with him in Canberra.

Nowhere have money and politics been as closely intertwined as in NSW. Both Labour party politicians Eddie Obeid and Ian MacDonald engaged in extensive business transactions where they were able to use their political positions to great advantage. Both were found to be corrupt by The Independent Commission Against Corruption (ICAC) in 2013.

The ABC Four Corners program Democracy for Sale screened on 23rd June 2014 looked at the issue of widespread corruption including in political donations in both parties.

Geoffrey Watson, a legal council who has had extensive experience with government anti-corruption bodies spoke out publicly on Radio National blowing the whistle on the problems in government anti-corruption bodies across Australia.

Watson describes the attempt to undermine the Crime and Misconduct Commission in Queensland. He addresses the unjustiified criticism of ICAC in NSW where it has exposed extensive corruption but was lucky to be supported by the leaders of both major parties. He considers the models in Victoria and South Australia to be flawed because politicians have not given these bodies the powers needed to investigate effectively. He describes attempts by the Greens to create an anti-corruption body in Canberra, something resisted by both major parties there. In the discussion of this paper it was pointed out that corruption in politics was a global problem.

Questions about ICAC: I personally do not think that ICAC, which Watson was so proud of, was always effective and willing to investigate politicians and their actions.  I recently learned that in the late 1990s Whistleblowers Australia was steering people away from ICAC as it felt it could not be trusted.  During that period I asked them to investigate whether a judge who had resigned in 1991 when ICAC investigated him for conduct which rendered him at risk of improper influence during the early 1990s had in fact been pressured by politicians and/or a criminal business organisation into giving them the decision they wanted. In 1993 the retired judge was appointed by the minister of health over the head of the Health Department to make a licence decision which government desperately wanted. 

The judge gave them the desired decision in the face of incontenstible evidence and strong advice from the department over whose head he had been appointed.  Similar bodies in other states accepted this evidence and acted on it. There was much in the FOI documents I obtained that suggested he may have been pressured.  When the judge's vulnerability to improper influence (he committed suicide when this was exposed) and the reason for his early retirement were revealed in 1996, I asked ICAC to investigate how he had been appointed and whether improper influence had been exerted on him.  ICAC refused to become involved on the basis that I had not supplied evidence. The Judges tragic story is here. If improper conduct in appointing him and pressure by politicians had been exposed, it would have had major political consequences.  This would have extended into federal politics where a member of the NSW1993 government had become a minister.

In his talk, Watson stresses the investigative powers needed by anti-corruption bodies and ICAC's use of these effective powers to expose political corruption. They were less willing in 1996.  My conclusion is that government anti-corruption bodies are often only as effective as the government of the day allows them to be.

The Senate

I referred earlier to the limitations of some of the of the senators who hold the balance of of power in Canberra.  One of these independents, Nick Xenophon, is a notable exception and has been a champion in the senate.  He is concerned that this problem is because of the way senators are elected.  He has written about the way the voting system we have in Australia distorts the electorate's intention in electing minor parties in the senate. He is pressing for change.

A human rights lawyers views

Julian Burnside is a renowned Australian barrister, human rights and refugee advocate. He was made an Officer of the Order of Australia in 2009 for service as a human rights advocate and to law.

Burnside gave a critical speech to the Labor National Conference in July 2015 and then published it for the public to read. He calls a spade a spade.  He is talking about our political system and specifically about labors failure as a political party.  Some of the comments could apply to both parties.

Burnside was of course, speaking about the inhumane treatment of asylum seekers. He described a constituent writing to a large number of labor politicians asking a few simple questions. Only a few responded and they avoided answering the questions. Those of us who have studied and been worried about aged care or any other concerning issue in society might have thought that Burnside was talking about that because this is what politics has become.

Burnside's negative view of the Abbott government as the worst in history is mirrored in an article Lessons unlearnt as Abbott grapples with Howard-era rejects in Smartcompany.com on 17 August 2015.  It describes Abbott's appointment of ministers who had failed in the Howard years or whom Howard had a low regard for.  They were now causing Abbott problems.  Unlike Howard, Abbott seemed to be incapable of learning from his mistakes.

The Abbott’s efforts to shield himself and his ministers from independent advice started early with "the rule that any director on a government board who was appointed by the previous Labor government will not be reappointed" (Link blocked by Pay Wall)

This was followed soon after by slashing or reducing the large number of independent community advisory bodies made up of experienced and knowledgeable members of the community that were an invaluable source of information and independent advice. It was clear that this government had an agenda and did not welcome information or advice.  ABC Radio Sunday Extra aired a program "What happens when government's can't or won't hear frank and fearless advice?" on 21st June.  It can still be downloaded here

The government has been proactive in passing legislation that intrudes into citizens privacy and limits their rights. Probably the most glaring example of this is the planned legislation to limit the rights of citizens to use the courts to block developments that will damage the environment - particularly the highly contentious Adani coal mine development in Queensland. The battle is described as lawfare in one article. 

The government's dependence on big corporations for support and the manner in which it has taken sides in any dispute is revealed in this. Its ability to fund successful electoral campaigns is likely to depend on strong support from this marketplace. The questions that arise are endless. When does legitimate lobbying become bribery? What sort of negotiations between government and developers have been going on? What undertakings have been given?  When do golden handshakes turn into golden handcuffs?  To what extent are the decisions that effect us constrained by these handcuffs and is aged care policy in handcuffs?

Satire

Andy Borowitz is a comedy writer for The New Yorker. He wrote a satirical piece about billionaire's buying politicians explaining how beneficial this was for them and society. Satire gains its bite by highlighting real life harmful social issues that we all know about but cannot stop.  If you badly need to laugh after all this, have a look at the following article:

Where to from here in politics?

Experienced corruption investigator Geoffrey Watson claims that "Australia is moving backwards and not forwards". The chances of politicians actually confronting their problems and serving the country with integrity seem remote. 

Scare tactics:  Very worrying is the way Abbott is employed scare tactics making mountains out of the terrorism threat including the overreaction to ABC’s Q&A program when it invited someone they considered to have been a terrorist but who was now speaking about that and not supporting it to ask a question and put their point of view.

It is well known that an anxious public will stick with the government they know and favour the government in office rather than try anything else. Howard used this with the TAMPA asylum seeker issue while in power. I write more about the reasons for this behaviour on the final slider on this page.

This tactic backfired when the Australian border police announced that they were going to assist Melbourne police in randomly checking documents and passports in Melbourne. This was overkill and within a few hours a massive public demonstration forced them to call off the operation.

Tony Windsor, the independent politician who worked with Oakeshott to give Gillard control in the hung parliament had had enough. He came out very publicly on the issue.

What to do: The debacle that is Australian politics looks as scary as the threat of terrorism. As a community, we need to rescue the situaion but how?  On the web page "Developments in social thought" I give links to some of the attempts to get citizens more directly involved and hopefully working with politicians.  I have no idea how these projects could actually address and contain what is happening but getting our citizens directly involved might be a beginning.  If they begin by taking control of some sectors and this is successful then it might extend further up in politics.

The tyranny of the majority and the rights of minorities as citizens in the aged care marketplace

Malcolm Turnbull is Sydney born and bred so his home is with the free trade advocates of the NSW faction of the liberal party. While he has made a number of blunders, he has behaved with far more decorum than most of his colleagues.  He has been prepared to debate with labor and compromise on things like climate change. Even though he was far more popular in the electorate he was far less so with the NSW right. 

Turnbull was leader of the coalition when in opposition, but Abbott defeated him by one vote when he challenged.  Turnbull is by far the most popular leader among voters and unless Abbott pulls something out of the hat he will probably lead the liberal party to the next election. He is very likely to win. The party will still be dominated by a right faction and a more moderate approach will be difficult. We do not know what his views of social services including aged care are so his speech “Magna Carta and the Rule of Law in the Digital Age” is of interest.

The talk is about the rule of law enshrined by the Magna Carta that protects minorities from tyrants.  It addresses the extent to which governments can reasonably abolish or reduce these rights in times of war and more specifically in response to terrorism. Turnbull’s measured and considered analysis sets him apart from the leader he will probably replace. No doubt that is carefully done but it does offer some hope for aged care. He indicates that the balance between security and liberty will always be controversial and that this is a good thing. He even refers to an audit by the Institute of public affairs, which is very critical of what the government has done.  This is what it says.

For those who are interested in these issues the Australian Law Reform Commission has issued an interim report Traditional Rights and Freedoms - Encoachment by Commonwealth Laws It is calling for submissions by 21st September 2015 before completing a final report.

What about the aged?: What Turnbull says about a liberal democracy may have more immediate relevance for aged care.

As a marginalised and often impaired minority, seniors might think about their rights as citizens. A state of war argument cannot be applied to aged care. The 21st century thinking about citizenship seeks to ensure that the vulnerable and marginalised are helped to exert their rights as citizens and not suffer from the decisions of the majority. The words “Consumer Directed Care (CDC)” indicates that this is intended. The worry is not with the intention - but with the way this has been done. Has the majority government failed to protect the rights of this group as citizens?

Extreme examples illustrate real issues. A Public Relations firm web site in the Uniting Kingdom capitalises on these driving forces in the aged care marketplace to recruit customers. It shows how hard aged care providers have to sell their services in glowing positive terms. If they don’t do so, they will not succeed. The carehome.co.uk referred to below, is a web site where nursing home companies put photos and supply details of the services they offer:

All this is to lure providers to employ a PR agency that will help them to entice the elderly and their families.  This is to sell "services" to vulnerable people in a system where those with knowledge and power will be under pressure to create this false impression and then exploit those getting services vulnerability in order to make more money and compete more sucessfully.

We all hope that most will not identify with this and not too many will actually do this. The point is that good care will be given in spite of the service and not because of it.  But experience shows that some will swallow this nonsense and then maximise the opportunities for profit.

Will citizenship in CDC simply be tokenistic? We can ask whether the government was meeting its obligation to protect the minority rights of this vulnerable group of citizens when it created an aged care market in 1997 without effective safeguards, and more recently when it did the same with CDC. The proposed aged care community hub is intended to address this issue and be there to help vulnerable citizens exert their rights in this market space.

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2. Politics, Health and Aged Care Reform

John Menadue who was Whitlam's secretary when Medicare was introduced, writes about the political barriers to health care reform (including aged care).

John Menadue was Private Secretary to Prime Minister Whitlam from 1960 to 1967. He has worked in government departments and in the business world. There is an interesting 2015 three part paper on Crikey and on his blog looking at the political barriers to reforming health care. The Whitlam influence is readily apparent, but there is a lot worth reading. He confirms what Rob Oakeshott said when he indicated that the necessary work does not get done and attributed this to the power of the market. Aged care has the same problems and Part 2: A big change to aged care is particularly relevant.

Moving aged care away from health

In 2013 during the election and after it, Abbott was intent on burying aged care and hiding it.

However, the government was under pressure on this issue and it has since devised and promoted a succession of changes without really engaging its critics in the community.

Moving aged care back to health: the story (Added Dec 2015)

The Abbott government had moved to rejuvenate John Howard’s 1997 policies including increased privatisation, giving the insurers the sort of power needed to make US managed care type changes, and moving to take postgraduate medical training away from professional colleges and contract it to commercial bidders.  This put his government at loggerheads with the medical profession whose capacity to provide the the sort of care they believed was in the best interersts of patients was being challenged.

The more consultative Susan Ley was eventyually made Minister for health in December 2014. She started talking to the medical profession. She indicated that “A key theme highlighted during consultations with health professionals - - - had been the connection between health and aged care”. When Turnbull deposed Abbott, Ley put up her hand to take over aged care. The portfolio was transferred back to the department of health and she remained minister.

Further progress: Ley has been more open and ready to consult but not as far as I know with the community and not much has changed in aged care. Perhaps like her new leader who was elected because of his public popularity she is constrained by the dominance of Abbott supporters in the parliamentary wing of the liberal party. Ken Wyatt was appointed Ley’s deputy with responsibility for aged care but we have not heard much from him. We should not expect real changes in policy to be made spontaneously or willingly.

• Sussan Ley appointed Minister for Aged Care Australian Ageing Agenda Sept 30, 2015

Ley sometimes seems to be making policy on the run.  She has been reluctant to take on key issues. Adequate staffing is the most critical issue for care and one of the major problems in our aged care system yet Ley dodges this. She has distanced herself from workforce issues saying ““It’s not within my area of res­ponsibility to set wages;”

The industry and unions are both frustrated that the long overdue audit of the workforce program has not yet been released and no one can move forward.  ACSA is talking of developing its own workforce policy and presenting this to government. It may be that the more sensible Ley is in conflict with the dominant right wing of her party which is still calling the shots.

• Aged care minister accused of ignoring worker pay issues Aged Care Insite 7 Oct 2015
• Frustrations rise over workforce Australian Ageing Agenda 2 December 2015

Ley might also turn her attention to eHealth where there is a lack of financial or other support to get aged care onto the eHealth system. But Ley needs to be wary of the “expert” advice she may get. eHealth is an advance which requires the close involvement of those employees who are going to use the system in both the design and implementation stages - it needs a multifaceted 21st century approach. Having managers, doctors or nurses dictate what they want to IT firms or programmers is a recipe for failure and there are many examples. Everyone involved needs to be heard and understand the world of the other, and get their hands dirty in design and implementation - a participatory process.

• Peaks angry aged care misses out on eHealth support Technology Review 12 Oct 2015
• People matter more than technology in IT implementation, provider advises Technology Review 12 October 2015

The arrival of a New Social Services minister to replace Morrison reveals how ignorant politicians can be when assuming office, but worse still how ignorant and out of touch with the community those who advise him are. The new minister's first public statement was to suggest saving money by cutting the funding for the Disability Support Pension and for carers of the disabled. He is targeting the vulnerable and their carers, the people who supply the bulk of disability care - care which the government simply can’t.  Even with the subsidy this must save government and taxpayer many millions.

• Social services minster has the wrong idea on spending Starts at Sixty Writer's Current affairs 16 Oct 2015

Academics are scathing about government's lack of policy and failure to address critical workforce issues in ageing. One describes it as “Clothed ears. Blinded eyes. Blunted policy; put it off until we absolutely need to attend to it. While in the interim, the people who are working in the industry and people being cared for in that industry sector are suffering.” The academics felt that providers could do much better in addressing staffing issues.

• Government blind to urgent workforce issues: expert Australian Ageing Agenda 23 Oct 2015

Pharmacists not happy

The government is now addressing the way pharmacies are run in a way that inhibits competition. It wants to open pharmacy to big businesses like Woolworths and Coles. On the linked article (below), the Pharmacy body's National president argues that the current system was set up for good reasons and is beneficial for society and the people it serves.

Harper Competition Review - March 2015

This article was written by Harper himself.

On the web page Competition Review in Part 2: A big change to aged care, I looked briefly at the recommendations of the Harper competition review. While he is recommending increased competition, to the uninitiated, there do seem to be some less gloomy bits in that he is considering human services as something different. This report is likely to have a big impact on the future direction of aged care. Unless he has some magic formula, more competition is likely to further compound our problems in aged care.  This may be an opportunity to go back to that page or if you are economically literate or interested to read his full report.

Harper a Recipe for "Stuff Ups" in Human Services

Ross Gittens, economic editor of the Sydney Morning Herald is scathing of Harpers recommendations for increasing competition and markets in human services. Rather like Robert Kuttner 20 years ago he points out that “belief that increased competition leads to greater efficiency and higher productivity is one of the articles of faith for admission to the economic priesthood”.

He is critical of their dependence on incentives and on increasing competitive pressure so integral to their model of markets. He asserts that “the most potentially alarming is Harper's proposal that the principles of competition policy be extended to the domain of "human services" – healthcare, education and community services”.  He describes this as “an old economists' trick: take an area that's always been outside the marketplace and marketise​ it. Take the world as it is and make it more like the textbook assumes it to be” by applying “the economists' two magic answers”. He points to the string of “stuff-ups” that have followed the contracting out of government services. He thinks they should try “a mighty lot harder than applying magic answers”.

• Let's not repeat our many competition stuff-ups post the Harper review Sydney Morning Herald 20 Nov 2015

Economy vs Social Stability

An article in The Conversation is critical of an excessive focus on the economy and markets and the neglect of society itself. It is worth reading in full (below).

Lessons from the USA

Lesley Russell from the University of Sydney wrote an interesting review of a book “America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix our Broken Healthcare System by Steven Brill”.  The book describes the battle to introduce universal healthcare (called Obamacare) in the USA. She indicates that she was involved in this as a “bit player” so was a close observer. She writes as an Australian criticising the book and looks at the lessons for Australia. She stresses the need for strong political leadership and compares this with the leadership displayed by Whitlam and Hawke during the battle to introduce of Medicare in Australia.

While this is about health care, it helps to expose the total lack of credible and effective leadership in Australia at a time when aged care desperately needs insightful attention. It is worth reading. One quote I think is directly applicable to Australia. In criticising the author's proposals to improve Obamacare by tinkering with commercial providers, Russell says:

On my web page documenting problems in the US market, I also commented on the USA’s total inability to confront this fundamental flaw in their system. Excellent books which accurately described what was happening and identified the problems were unable to propose a logical solution. They would not have been seen as credible in the USA if they had. I quoted extensively from one of these “Critical Condition: How Health Care in America Became Big Business & Bad Medicine” on a web page The Financial Institutions in Health Care which I wrote in 2004. The book accurately described what was happeing in the USA with numerous examples illustrating how and why.

We can ask whether this would have happened in Australia if citizens and the medical profession had not succeeded in forcing the big corporations responsible and described in this book out of Australia.  As early as 1993, the West Australian Health Department considered that this was possible. In a memorandum obtained under FOI, they urged their state government to address the risk. Their advice was ignored.

While Obama has had the courage and the leadership to confront and tackle these problems in health care, Australia is still locked into its political straight jacket and Abbott has been pursuing these failed policies in aged care.

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3. Globalisation of Health and Aged Care

This slider is about politics and globalisation. Many are concerned about the impact on health and aged care of decisions based on advice from businessmen who have little understanding of these sectors and without consulting those who care and those who receive care. There are concerns that for them the logical next step will be  to contract health care of our citizens to other countries where it will cost less. 

But we should be more concerned that they see selling aged care services to other countries as an important solution to our financial problems.  To enable us to do this they are pursuing domestic policies that are not all in the best interests of citizens, particularly to the elderly who are dispensible now that they no longer contribute to the economy.

Trade agreements have social consequences

One of the consequences of the neoliberal obsession with markets is that they are seen as the panacea for everything and globalisation of markets as an ultimate good that will benefit us and the world. They consult and listen to true believers and the marketplace and attack those in the community who raise issues about the consequences. The virulent aggression with which this is done by parliamentarians when confronted by environmental arguments, speaks for the importance to them of protecting the barriers that they have built to protect their ideas.

But our societies are not made up solely of markets. Society is a complex structure and its various parts are interdependent. What may be good for the market can and often does have serious adverse consequences for the other parts of society (the article below gives health care as an example) and also for the environment that we inhabit and that sustains us. A paper from the Centre for European Studies at Australian National University addresses these issues and is well worth reading.

It points out that our government is consulting only the business community and of course it then sells what has been decided to the rest of us. That sales pitch does not contain the information we need to debunk it. This paper calls for much wider discussion across all sections of the community. Its worth looking at.

A Senate Foreign Affairs, Defence and Trade References Committee report addresses some of the same issues.

Trade Agreements of concern for aged care

The government has recently negotiated a trade agreement with China. We don't know much about it except that services like health and aged care are part of the deal. Ian Yates gave a TV interview promoting its financial potential for our aged care sector. He is from the seniors group COTA.  He is the person that both NACA and the government seem to work with when they want a community representative to promote aged care policy.  He is a member of NACA and clearly believes in the direction aged care is being taken.

An article in The Age reports on a leaked secret document from the international Trade in Services Agreement (TiSA) negotiations. Although it is about health and not directly applicable to aged care, if accurate, it tells us about government policy and the way it operates and keeps the public informed. Its probably not really about tourism, but headlines are to attract attention.

This, of course, is not new. At the end of the 1980s, Doug Moran and Tom Wenckart both wanted to build luxury Medical Plazas and service the wealthy from Asia (see links above). They were strong supporters of Prime Minister Howard and at the end of the 1990s Howard's government was very active in promoting globalisation including of health.  It led the way in eliminating local barriers to "legitimate trade" by multinationals, including probity requirements in aged care. There was publicity and medical opposition to these policies. They backed away from health care. I wrote about this in 2000.

If what is reported is true, as seems likely, (The minister did not deny it), then we might think about the economies obtained by contracting the care of people on public waiting lists to a hospital in Asia where costs are much lower than it would be to contract to our private hospitals as they do now - and cheaper than building hospitals here and staffing them.  Hopefully the government won't get away with that at the moment! The medical profession have too often had to sort out botched outcomes for those Australians who have been tempted by offers of cheap surgery linked to travel packages by companies in other countries.

Update Oct 2015

The TPP agreement has now been concluded but not yet ratified. I have not seen any comments about health or aged care in regard to the TPP.  The truly worrying thing about all this is that it is all secret and citizens in none of the countries will see the agreement until signed and much of it only after 5 years. There may be genuine benefits in this agreement for us but we know that our politicians on both sides cannot be trusted and are in debt to the big end of the market at one end and the unions at the other. There is hardly anyone representing civil society.  We are being denied access to information about this. What has happened to democracy?

It seems that this is the first of the three TPP (Trans-Pacific Partnership), TIPP (Transatlantic Trade and Investment Partnership) and the TISA agreements. The TISA (Trade in Services Agreement) is the one that will have most impact on health and aged care in Australia.

Wikileaks has obtained and released multiple draft TISA documents and it is clear that many of the clauses, if they are agreed to as seems likely, would seriously erode the rights of citizens and prevent governments from legislating to protect them. The leaked documents reveal that an external international court whose composition is highly suspect, would have jurisdiction over what Australia does and can stop if from acting in the best interest of its citizens.

The allegations being made suggest that it is the big corporate multinationals that are driving this process and working through their governments.

No reasonable explanation has been given for this secrecy and the only sensible conclusion that anyone can reach is that, if it were made public, the vast majority of us would not accept it and there would be a massive backlash.

Here are some links.

• TTIP, TISA Explained | Wikileaks | Jeremy Corbyn | Bernie Sanders | Julian assange Utube video interviews 27 Aug 2015
• Trade in Services Agreement Wikipedia 
• WikiLeaks releases documents related to controversial US trade pact The Guardian 4 Jun 2015
• The Scariest Trade Deal Nobody's Talking About Just Suffered a Big Leak New Republic 4 June 2015
• Just Before Round of Negotiations on the Proposed 'Trade in Services Agreement' (TISA), Wikileaks Releases Updated Secret Documents The Huffington Post 3 July 2015
• Trade in Services Agreement  List of TISA documents released by wikileaks

What future for democracy? If, as the critics claim, there are no good reasons for this secrecy and no one can justify it then we really need to be very worried. Is the incredible and bizarre actually possible? Is there now an ideology within democracy that is so convinced by what it believes that it has aculturated our political system and is actually destroying democracy in order to meet its objectives.  Is it doing this in the name of democracy itself?  If so then Democracy has never been as seriously challenged before. This is blatant censorship and once we accept that then democracy ceases to exist.

If, as the the YouTube video suggests (and I am not claiming it is) this is all about the USA and its businessmen protecting their interests and walling off China, India, Russia and other growing financial powers that are excluded from the agreements then it is little wonder that the Russians and Chinese are flexing their muscles and responding in Ukraine, Syria and the South Chinese Sea.

Globalisation: We live in a global society and globalisation offers enormous opportunities. But globalisation is about civil societies interacting and building relationships. Markets become part of that when they serve society and are transparently seen to do so. The word globalisation has been appropriated by markets and politicians. It has become a secret process from which civil society is excluded.

We need to remember what Adam Smith the father of economic theory said over 200 years ago.

 The proposal of any new law or regulation of commerce which comes from this order ... ought never to be adopted, till after having been long and carefully examined ... with the most suspicious attention. It comes from an order of men ... who have generally an interest to deceive and even oppress the public

Sacrificing the old when they no longer contribute (added Dec 2015)

Economics dominates political discussion. Politicians make no secret of the fact that they see a trade in human services by Australian multinational companies as a major contributor to the Australian economy. They see it as essential now that the mining boom is over and we go further into debt. We have to see recent developments in aged care within this context.

Political objectives: To accomplish their objective politicians need human services to adopt and identify with the market model. To succeed industries will have to consolidate into large market listed and private equity corporate chains. They have the size, the wealth and the business skills to capitalise on opportunities and succeed in this global market. This thinking was behind the market reforms initiated in 1997.

The recent downturn in Australia’s financial position has driven the government to increase government and private funding and add to the competitive pressure.  This will speed up the corporatisation and consolidation of the sector. Markets only grow when there is enough money to stimulate this growth. This is being done under the guise of the “Living longer living better” reforms. It has also influenced the way that Consumer Directed Care (CDC) has been set up as a competitive market.

The evidence: On the web page Policy and Evidence I link to the extensive international evidence collected by Baldwin and his co-workers. Their own research analysing the limited data available in Australia showed a similar trend. There is now clear data showing that the for-profit chains have significantly poorer outcomes than not-for-profit providers and that private equity performs even worse than that. Care is also worse in the larger, more profitable aged care facilities that the for-profit sector prefers.

Generally the stronger the focus on markets and market style management the poorer the outcomes. If countries are compared then generally those with a strongly competitive market in health and aged care pay more per capita for similar or poorer care than those with a less market focussed system. More of this increase in the cost of care is born by individuals themselves rather than being born by tax or broad insurance schemes.

Under this pressure the not-for-profit providers are increasingly adopting similar thinking and similar management strategies. It is therefore likely that the care they provide is being negatively impacted but we do not have evidence for this.

To my knowledge much of this information has been readily available since 1994. It was drawn to the attention of our politicians at least by the end of 1997 - more has become available since.

Ignoring the interests of older citizens: It seems obvious that the wellbeing and best interests of older citizens are being sacrificed in order to boost our economy. These are the people who have worked hard to build this country's prosperity since the 2nd World war but are no longer needed or able to contribute  This policy ensures that each generation will suffer the same fate when its members enter the last few years of their lives.

The question of course is whether this is something that has been systematically planned and something that our current policy makers are deliberately proceeding with. We might argue that in order to do so they are deliberately keeping us in the dark. That our society is ageist and disengaged makes it easy for them to do so.

My own view, based on the paradigms of analysis that I explain in Part 5, is that this is not so. When ideologies develop the pressures in the systems they create result in the unwitting adoption of a variety of psychological strategies that lead participants to not look, to not see and then not acknowledge what is before them. A variety of interactive peer and group social processes reinforce this and lead to the labelling and discrediting of critics.

When we are too far down this path we may be so trapped and so involved that we cannot turn back. Even when we recognise what is happening we may deliberately continue to do these things. We may be so trapped by the positions we have taken and the pressures from those around us that we continue down this path even when we know exactly what the consequences of what we are doing are. It can become conscious and deliberate. Some of us may be so uncomfortable that we retire or move elsewhere but we don’t discredit ourselves by speaking out. I think we are close to that stage in aged care now, but with much of the world on this path it is almost impossible for true committed believers to turn back.

Open participatory government: This is why the Open Government project is so important for the world as well as Australia, and why participatory democracy is such a vital and essential part of this. An open participatory model of democracy will tap into the diversity of knowledge and experience across the community. The issues will be raised and the data will be collected by those who realise its importance. The issues must then be confronted and addressed in the resulting debate.

Participation builds citizenship, skills, knowledge and the confidence to back that up by acting. It builds “social capital” and reverses the “hollowing out” of communities that critical analysts have detected. This destroys citizen’s confidence in themselves and prevents them from confronting dominant belief systems that don't serve citizens.

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